Organization
VERDUROUS ME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEESA HANKSNECHT (OWNER)
(248) 420-7439
Entity
Organization
Contact information
Practice address
49881 GRAND RIVER AVE, WIXOM, MI 48393-3309
(248) 229-4016
Mailing address
25645 INGLESIDE DR, SOUTHFIELD, MI 48033-4844
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
—
—
175L00000X
Homeopath
68663511
MI
2255A2300X
Athletic Trainer
18966MIPFT
MI
225700000X
Massage Therapist
Primary
7501010100
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106H00000X
MARRIAGE & FAMILY SPECIALIST
MI
01
—
133NN1002X
NUTRITION SPECIALIST
MI
01
—
174H00000X
HEALTH EDUCATOR
MI
01
—
175L00000X
HOMEOPATH
MI
01
—
2255A2300X
SPECIALIST ATHLETIC TRAINER
MI
Enumeration date
06/21/2017
Last updated
06/22/2017
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