Healthcare Provider Details

I. General information

NPI: 1821777335
Provider Name (Legal Business Name): INTEGRATIVE HEALTH & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 W MAIN STREET SUITE 3
EPHRATA PA
17522
US

IV. Provider business mailing address

1656 W MAIN ST STE 5
EPHRATA PA
17522-1103
US

V. Phone/Fax

Practice location:
  • Phone: 717-863-5387
  • Fax:
Mailing address:
  • Phone: 717-998-0078
  • Fax: 717-844-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE RENEE LUNDY
Title or Position: OWNER, PROVIDER
Credential: CRNP
Phone: 717-998-0078