# INNOVATIVE HEALTH AND WELLNESS CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265862676
- **Authorized official:** SUMMER YVONNE TILGNER FNP (OWNER)
- **Authorized official phone:** (928) 854-7666

## Contact information

- **Practice address:** 297 LAKE HAVASU AVE S, 200, LAKE HAVASU CITY, AZ 86403-6526
- **Practice address phone:** (928) 854-7666
- **Practice address fax:** (928) 854-7660
- **Mailing address:** 297 LAKE HAVASU AVE S, 200, LAKE HAVASU CITY, AZ 86403-6526
- **Mailing address phone:** (928) 854-7666
- **Mailing address fax:** (928) 854-7660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WG0000X | General Practice Registered Nurse | 13-00030589 | AZ | Yes |

## Other

- **Enumeration date:** 11/21/2013
- **Last updated:** 11/21/2013