MEDICARE: INTEGRATED HEALTH & WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1245823699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED HEALTH & WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 264
Second Line	:
City	:	TAYLOR
State	:	MI
Zip	:	48180-0264
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 SOUTH ST
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-2946
Country	:	US
Telephone Number	:	734-210-3246
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EUCHERIA MBATA
Credential	:	NP
Telephone Number	:	734-210-3246

Provider Enumeration Date	:	02/17/2021
Last Update Date	:	04/30/2024

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