Provider Demographics
NPI:1154449015
Name:LIFETIME CONNECTIONS INC. DBA ADVANCED WELLNESS CONNECTIONS
Entity Type:Organization
Organization Name:LIFETIME CONNECTIONS INC. DBA ADVANCED WELLNESS CONNECTIONS
Other - Org Name:ADVANCED WELLNESS CONNECTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, GCFP
Authorized Official - Phone:425-282-0406
Mailing Address - Street 1:821 S. 219ST #8
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198
Mailing Address - Country:US
Mailing Address - Phone:425-282-0406
Mailing Address - Fax:206-824-7378
Practice Address - Street 1:981 POWELL AVE SW
Practice Address - Street 2:SUITE 130
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2990
Practice Address - Country:US
Practice Address - Phone:425-282-0406
Practice Address - Fax:425-282-0404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFETIME CONNECTIONS INC. DBA ADVANCED WELLNESS CONNECTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 8877174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty