Healthcare Provider Details

I. General information

NPI: 1407451941
Provider Name (Legal Business Name): OPTIMAL HEALTH AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1657 WHITE CLIFF DR
HOWELL MI
48843-8187
US

IV. Provider business mailing address

1657 WHITE CLIFF DR
HOWELL MI
48843-8187
US

V. Phone/Fax

Practice location:
  • Phone: 517-902-1102
  • Fax:
Mailing address:
  • Phone: 517-902-1102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOELLE WENDEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 517-902-1102