Healthcare Provider Details

I. General information

NPI: 1447975891
Provider Name (Legal Business Name): UPLIFTING WOMEN'S WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 01/07/2024
Certification Date: 01/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36650 GRAND RIVER AVE STE 101
FARMINGTON MI
48335-2919
US

IV. Provider business mailing address

36650 GRAND RIVER AVE STE 101
FARMINGTON MI
48335-2919
US

V. Phone/Fax

Practice location:
  • Phone: 734-691-0980
  • Fax:
Mailing address:
  • Phone: 734-691-0980
  • Fax: 989-607-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LESLIE CORNWELL
Title or Position: OFFICE DIRECTOR
Credential: CNM
Phone: 734-691-0980