Healthcare Provider Details

I. General information

NPI: 1720646508
Provider Name (Legal Business Name): SUUNTA INTEGRATIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 N 3RD ST
MARQUETTE MI
49855-3009
US

IV. Provider business mailing address

1600 BAYVIEW DR
MARQUETTE MI
49855-5025
US

V. Phone/Fax

Practice location:
  • Phone: 906-286-3254
  • Fax:
Mailing address:
  • Phone: 906-286-3254
  • Fax: 906-273-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MELISSA ANN COPENHAVER
Title or Position: OWNER
Credential: DNP, FNP-BC, LMSW
Phone: 906-286-3254