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General NPI Number Information
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NPI Number | 1760298004
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Entity Type | Organization
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Legal Business Name | LIVE WELL INTEGRATIVE HEALTH AND SERVICES, LLC
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 7683 WYLDWOOD WAY
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-3008
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Country | US
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Telephone | 772-216-3546
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Fax |
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Provider Business Mailing Address
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Address Line | 7683 WYLDWOOD WAY
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-3008
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Country | US
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Telephone | 772-216-3546
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DANIELLE ELIZABETH STEPHENS
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Credential | ARNP
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Telephone | 772-216-3546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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