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General NPI Number Information
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NPI Number | 1396424438
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Entity Type | Organization
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Legal Business Name | VYVE WELLNESS LAKE NORMAN
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 136 CORPORATE PARK DR STE G
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City | MOORESVILLE
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State | NC
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Zip | 28117-6960
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Country | US
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Telephone | 704-412-3616
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Fax |
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Provider Business Mailing Address
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Address Line | 497 N WENDOVER RD
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City | CHARLOTTE
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State | NC
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Zip | 28211-1064
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Country | US
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Telephone | 828-712-0102
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM CHRISTIAN HAAS III
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Credential | MD
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Telephone | 828-712-0102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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