Provider Demographics
NPI:1598410714
Name:INTEGRATIVE LIFE
Entity Type:Organization
Organization Name:INTEGRATIVE LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, ACNP
Authorized Official - Phone:480-522-8278
Mailing Address - Street 1:2218 E ANCHOR DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3866
Mailing Address - Country:US
Mailing Address - Phone:480-522-8278
Mailing Address - Fax:
Practice Address - Street 1:2218 E ANCHOR DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-3866
Practice Address - Country:US
Practice Address - Phone:480-522-8278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No251F00000XAgenciesHome Infusion