MEDICARE: INTEGRATIVE & HOLISTIC HEALTH 4 LIFE, 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	RN.285897-COA-1	OH

General Provider Information

NPI Number	:	1487179420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE & HOLISTIC HEALTH 4 LIFE, LLC

Provider Business Mailing Address
First Line	:	5300 E MAIN ST STE 112
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2580
Country	:	US
Telephone Number	:	614-636-3510
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 E MAIN ST STE 112
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2580
Country	:	US
Telephone Number	:	614-636-3510
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MELINDA A SKIPPER
Credential	:	CNP
Telephone Number	:	614-636-3510

Provider Enumeration Date	:	08/10/2017
Last Update Date	:	07/21/2022

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