Healthcare Provider Details

I. General information

NPI: 1427966175
Provider Name (Legal Business Name): NURTURED ROOTS OF WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WOLF CT
EAST LANSING MI
48823-1869
US

IV. Provider business mailing address

1200 WOLF CT
EAST LANSING MI
48823-1869
US

V. Phone/Fax

Practice location:
  • Phone: 734-985-8662
  • Fax:
Mailing address:
  • Phone: 734-985-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL R DAVIS-DUNN
Title or Position: OWNER
Credential: LMSW
Phone: 734-985-8662