Healthcare Provider Details

I. General information

NPI: 1285030239
Provider Name (Legal Business Name): CENTER FOR INTEGRATIVE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N CEDAR ST STE 200
LANSING MI
48906-5334
US

IV. Provider business mailing address

1106 N CEDAR ST STE 200
LANSING MI
48906-5334
US

V. Phone/Fax

Practice location:
  • Phone: 517-455-7455
  • Fax:
Mailing address:
  • Phone: 517-455-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberNT60503141
License Number StateWA

VIII. Authorized Official

Name: DR. LANAE KELLY MULLANE
Title or Position: NATUROPATHIC RESIDENT
Credential: N.D.
Phone: 928-830-5219