Provider Demographics
NPI:1336925080
Name:KULANI SPA & WELLNESS
Entity Type:Organization
Organization Name:KULANI SPA & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SABINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:716-341-8123
Mailing Address - Street 1:1365 ROCK QUARRY RD STE 304
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5024
Mailing Address - Country:US
Mailing Address - Phone:678-884-6555
Mailing Address - Fax:678-826-0772
Practice Address - Street 1:1365 ROCK QUARRY RD STE 304
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5024
Practice Address - Country:US
Practice Address - Phone:678-884-6555
Practice Address - Fax:678-826-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty