Healthcare Provider Details

I. General information

NPI: 1083276547
Provider Name (Legal Business Name): FUNDAMENTAL HEALING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29829 TELEGRAPH RD STE 204
SOUTHFIELD MI
48034-1330
US

IV. Provider business mailing address

29829 TELEGRAPH RD STE 204
SOUTHFIELD MI
48034-1330
US

V. Phone/Fax

Practice location:
  • Phone: 248-601-0234
  • Fax: 844-273-8145
Mailing address:
  • Phone: 248-601-0234
  • Fax: 844-273-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SH1100X
TaxonomyHolistic Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: GRETCHEN PERRY
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP-BC, NP-C
Phone: 313-715-4835