Provider Demographics
NPI:1407527203
Name:SUNRISE WELLNESS SOLUTION PLLC
Entity Type:Organization
Organization Name:SUNRISE WELLNESS SOLUTION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:660-723-0953
Mailing Address - Street 1:5287 S HIGHWAY 95 STE I
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-9220
Mailing Address - Country:US
Mailing Address - Phone:928-577-2024
Mailing Address - Fax:970-788-1820
Practice Address - Street 1:5287 S HIGHWAY 95 STE I
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9220
Practice Address - Country:US
Practice Address - Phone:928-577-2024
Practice Address - Fax:970-788-1820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy