Provider Demographics
NPI:1396289120
Name:NEXT LEVEL UP HEALTH & WELLNESS INC.
Entity type:Organization
Organization Name:NEXT LEVEL UP HEALTH & WELLNESS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHIFFON
Authorized Official - Middle Name:E
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-618-7561
Mailing Address - Street 1:27436 AVONDALE ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1787
Mailing Address - Country:US
Mailing Address - Phone:734-664-4729
Mailing Address - Fax:734-895-6230
Practice Address - Street 1:28423 PARKWOOD ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1669
Practice Address - Country:US
Practice Address - Phone:313-618-7561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty