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General NPI Number Information
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NPI Number | 1194935387
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Entity Type | Organization
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Legal Business Name | HEART AND WELLNESS INSTITUTE
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 5043 CASCADE RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3724
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Country | US
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Telephone | 616-719-5939
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Fax | 616-719-5933
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Provider Business Mailing Address
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Address Line | 5043 CASCADE RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3724
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Country | US
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Telephone | 616-719-5939
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Fax | 616-719-5933
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Authorized Official
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Title or Position | ADMIN / OFFICE MGR
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Name | MRS. BARBARA ANNETTE WARREN
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Credential | MSM
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Telephone | 616-719-5939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4301080691
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License Number State | MI
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