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General NPI Number Information
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NPI Number | 1134039761
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Entity Type | Organization
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Legal Business Name | FLOURISH MIDLIFE MEDICAL CORP
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 140 SHADOWBROOK ST
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City | LOLETA
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State | CA
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Zip | 95551-9409
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Country | US
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Telephone | 530-520-0014
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Fax | 707-783-2963
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Provider Business Mailing Address
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Address Line | PO BOX 240
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City | LOLETA
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State | CA
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Zip | 95551-0240
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Country | US
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Telephone | 530-520-0014
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Fax | 707-783-2963
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | NOELLE E GUNN
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Credential | NP
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Telephone | 530-520-0014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083T0002X
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Taxonomy Name | Medical Toxicology (Preventive Medicine) Physician
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License Number |
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License Number State |
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