Healthcare Provider Details

I. General information

NPI: 1578270229
Provider Name (Legal Business Name): LANITH HEALTH & WELLNESS LAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/02/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 DUENKE DR
SAINT LOUIS MO
63137-1103
US

IV. Provider business mailing address

1228 DUENKE DR
SAINT LOUIS MO
63137-1103
US

V. Phone/Fax

Practice location:
  • Phone: 314-356-1962
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: LORRAINE BEAMON
Title or Position: OWNER
Credential:
Phone: 314-356-1962