Provider Demographics
NPI:1093289472
Name:MERIDIAN WELLNESS, LLC
Entity Type:Organization
Organization Name:MERIDIAN WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:LEILANI
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVAR
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:802-999-5936
Mailing Address - Street 1:PO BOX 1497
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:UT
Mailing Address - Zip Code:84716-1497
Mailing Address - Country:US
Mailing Address - Phone:435-335-7700
Mailing Address - Fax:
Practice Address - Street 1:842 W HWY 12
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:UT
Practice Address - Zip Code:84716
Practice Address - Country:US
Practice Address - Phone:435-335-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1851635833OtherINDIVIDUAL NPI