Healthcare Provider Details

I. General information

NPI: 1841902574
Provider Name (Legal Business Name): RADIANT HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 PLAINFIELD AVE NE STE A
GRAND RAPIDS MI
49505-4706
US

IV. Provider business mailing address

PO BOX 150165
GRAND RAPIDS MI
49515-0165
US

V. Phone/Fax

Practice location:
  • Phone: 616-219-0390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHIAHUI NEILLY
Title or Position: FOUNDER/CEO
Credential: DNP, FNP-BC, PMHNP-B
Phone: 616-219-0390