Provider Demographics
NPI:1508590803
Name:LAFAYETTE FAMILY WELLNESS, LLC
Entity Type:Organization
Organization Name:LAFAYETTE FAMILY WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-570-2448
Mailing Address - Street 1:179 W 550 S
Mailing Address - Street 2:
Mailing Address - City:CUTLER
Mailing Address - State:IN
Mailing Address - Zip Code:46920-9307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4050 BRITT FARM DR STE C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-0712
Practice Address - Country:US
Practice Address - Phone:937-570-2448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty