Provider Demographics
NPI:1871927632
Name:WELLNESS NP OF MICHIGAN, LLC
Entity type:Organization
Organization Name:WELLNESS NP OF MICHIGAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:BLAESSER
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:248-721-9878
Mailing Address - Street 1:2530 CROOKS RD
Mailing Address - Street 2:STE 3
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3300
Mailing Address - Country:US
Mailing Address - Phone:248-721-9878
Mailing Address - Fax:
Practice Address - Street 1:2530 CROOKS RD
Practice Address - Street 2:STE 3
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3300
Practice Address - Country:US
Practice Address - Phone:248-721-9878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704186755261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care