Provider Demographics
NPI:1902784887
Name:ELEVATED HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:ELEVATED HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ANISE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:219-224-3205
Mailing Address - Street 1:2539 WILLOWCREEK RD # 1063
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-3015
Mailing Address - Country:US
Mailing Address - Phone:219-224-3205
Mailing Address - Fax:219-803-1404
Practice Address - Street 1:2539 WILLOWCREEK RD # 1063
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-3015
Practice Address - Country:US
Practice Address - Phone:219-224-3205
Practice Address - Fax:219-803-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care