Provider Demographics
NPI:1851144901
Name:CONCIERGE HEALTH LLC
Entity Type:Organization
Organization Name:CONCIERGE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:928-486-6135
Mailing Address - Street 1:1600 MCCULLOCH BLVD N STE 3A
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-0959
Mailing Address - Country:US
Mailing Address - Phone:928-486-6135
Mailing Address - Fax:
Practice Address - Street 1:1600 MCCULLOCH BLVD N STE 3A
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-0959
Practice Address - Country:US
Practice Address - Phone:928-486-6135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty