Provider Demographics
NPI:1255883054
Name:LIFESTYLE HEALTH INSTITUTE, LLC
Entity type:Organization
Organization Name:LIFESTYLE HEALTH INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:786-205-4125
Mailing Address - Street 1:13610 N SCOTTSDALE RD
Mailing Address - Street 2:10
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4037
Mailing Address - Country:US
Mailing Address - Phone:786-205-4125
Mailing Address - Fax:
Practice Address - Street 1:9375 E SHEA BLVD
Practice Address - Street 2:100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6991
Practice Address - Country:US
Practice Address - Phone:786-205-4125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty