Healthcare Provider Details

I. General information

NPI: 1780243683
Provider Name (Legal Business Name): NORTHWEST BREATHING & WELLNESS CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W PARNALL RD
JACKSON MI
49201-8660
US

IV. Provider business mailing address

1500 W PARNALL RD
JACKSON MI
49201-8660
US

V. Phone/Fax

Practice location:
  • Phone: 517-513-8070
  • Fax: 517-795-2687
Mailing address:
  • Phone: 517-513-8070
  • Fax: 517-795-2687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIANNE ELIZABETH MEZO
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 517-513-8070