Healthcare Provider Details

I. General information

NPI: 1235095597
Provider Name (Legal Business Name): NOVALEO WEIGHT AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 LEONARD ST NE
GRAND RAPIDS MI
49505-5637
US

IV. Provider business mailing address

1805 LEONARD ST NE
GRAND RAPIDS MI
49505-5637
US

V. Phone/Fax

Practice location:
  • Phone: 616-801-4648
  • Fax: 616-319-2966
Mailing address:
  • Phone: 616-801-4648
  • Fax: 616-319-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN LONG
Title or Position: OWNER
Credential: FNP-C
Phone: 616-801-4648