Provider Demographics
NPI:1467218271
Name:REIMAGINE WEIGHT LOSS AND WELLNESS, INC
Entity Type:Organization
Organization Name:REIMAGINE WEIGHT LOSS AND WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:616-403-0326
Mailing Address - Street 1:23 WHITES PATH STE G
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-1238
Mailing Address - Country:US
Mailing Address - Phone:888-335-7574
Mailing Address - Fax:866-874-1023
Practice Address - Street 1:23 WHITES PATH STE G
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-1238
Practice Address - Country:US
Practice Address - Phone:888-335-7574
Practice Address - Fax:866-874-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty