MEDICARE: WHOLELIFE FUNCTIONAL MEDICINE 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

General Provider Information

NPI Number	:	1346191624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLELIFE FUNCTIONAL MEDICINE LLC

Provider Business Mailing Address
First Line	:	8911 CAM DR
Second Line	:
City	:	FRANKLIN
State	:	OH
Zip	:	45005-3001
Country	:	US
Telephone Number	:	937-825-5517
Fax Number	:	937-825-5517

Provider Business Practice Location Address
First Line	:	8911 CAM DR
Second Line	:
City	:	FRANKLIN
State	:	OH
Zip	:	45005-3001
Country	:	US
Telephone Number	:	937-825-5517
Fax Number	:	937-825-5517

Authorized Official
Title or Position	:	OWNER
Name	:	ZACHARY JAMES HALE
Credential	:	NP
Telephone Number	:	937-825-5517

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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