Provider Demographics
NPI:1225891922
Name:ADVANCED HEALTH & WELLNESS
Entity Type:Organization
Organization Name:ADVANCED HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAKIESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:541-414-0481
Mailing Address - Street 1:1745 DRAGON TAIL PL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7290
Mailing Address - Country:US
Mailing Address - Phone:850-867-0353
Mailing Address - Fax:
Practice Address - Street 1:900 BIDDLE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6118
Practice Address - Country:US
Practice Address - Phone:850-867-0353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care