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General NPI Number Information
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NPI Number | 1740070614
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Entity Type | Organization
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Legal Business Name | LMM WELLNESS LLC
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 196 W 12300 S STE 105
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City | DRAPER
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State | UT
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Zip | 84020-8090
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Country | US
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Telephone | 617-694-5173
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Fax | 801-705-0579
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Provider Business Mailing Address
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Address Line | 2810 N CHURCH ST # 159893
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City | WILMINGTON
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State | DE
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Zip | 19802-4447
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Country | US
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Telephone |
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Fax | 801-705-0579
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. GIAVONNI LEWIS
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Credential | MD
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Telephone | 617-694-5173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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