=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174497010
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARMONY HILLS WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2025
-----------------------------------------------------
Last Update Date | 10/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14799 DIX TOLEDO RD
-----------------------------------------------------
City | SOUTHGATE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48195-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-304-0901
-----------------------------------------------------
Fax | 734-805-9227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24306 THORN DR
-----------------------------------------------------
City | FLAT ROCK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48134-6037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-304-0901
-----------------------------------------------------
Fax | 734-805-9227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP
-----------------------------------------------------
Name | MRS. NWAKAEGO LISA UWAEZUOKE
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 734-299-6131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------