Provider Demographics
NPI:1942765417
Name:KYLA NUTRITION & WELLNESS
Entity Type:Organization
Organization Name:KYLA NUTRITION & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEESE
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD, CEDS, CPT
Authorized Official - Phone:248-766-9627
Mailing Address - Street 1:4758 BROOMFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1956
Mailing Address - Country:US
Mailing Address - Phone:248-766-9627
Mailing Address - Fax:
Practice Address - Street 1:4758 BROOMFIELD WAY
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1956
Practice Address - Country:US
Practice Address - Phone:248-766-9627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A