Healthcare Provider Details

I. General information

NPI: 1538730924
Provider Name (Legal Business Name): LINDSEY MARIE WYATT DIPL. AC, L.AC,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23650 WOODWARD AVE STE 108
PLEASANT RIDGE MI
48069-1141
US

IV. Provider business mailing address

367 W PEARL AVE
HAZEL PARK MI
48030-1734
US

V. Phone/Fax

Practice location:
  • Phone: 248-318-8615
  • Fax:
Mailing address:
  • Phone: 248-318-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5402000051
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: