=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760331599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARMONY HEALTH & WELLNESS CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2026
-----------------------------------------------------
Last Update Date | 01/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2169 SWANSON AVE STE 1
-----------------------------------------------------
City | LAKE HAVASU CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86403-6878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-575-2090
-----------------------------------------------------
Fax | 480-885-3157
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2169 SWANSON AVE STE 1
-----------------------------------------------------
City | LAKE HAVASU CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86403-6878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-575-2090
-----------------------------------------------------
Fax | 480-885-3157
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISTY PETERSEN
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 928-208-9707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------