Healthcare Provider Details

I. General information

NPI: 1871816520
Provider Name (Legal Business Name): BLUE ROSE HOLISTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COURT ST N
RIPLEY WV
25271-1207
US

IV. Provider business mailing address

101 COURT ST N
RIPLEY WV
25271-1207
US

V. Phone/Fax

Practice location:
  • Phone: 304-532-5412
  • Fax:
Mailing address:
  • Phone: 304-532-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. LORI A MITCHELL-LEE
Title or Position: OWNER/PRACTITIONER
Credential: ND
Phone: 304-532-5412