Provider Demographics
NPI:1609552173
Name:ELEVATE MEDICAL AESTHETICS AND WELLNESS
Entity Type:Organization
Organization Name:ELEVATE MEDICAL AESTHETICS AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:231-622-8103
Mailing Address - Street 1:413 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:949-695-2102
Practice Address - Street 1:413 HOWARD ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2621
Practice Address - Country:US
Practice Address - Phone:231-622-8103
Practice Address - Fax:949-695-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty