Organization
LIFESTYLE WELLNESS LLC
Active
Other names
Lifestyle Wellness LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. COLLEEN PETULLO NP (NURSE PRACTITIONER)
(928) 288-0500
Entity
Organization
Contact information
Practice address
3192 N WINDSONG DR, PRESCOTT VALLEY, AZ 86314-2239
(928) 288-0500
Mailing address
3192 N WINDSONG DR, PRESCOTT VALLEY, AZ 86314-2239
(928) 288-0500
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/20/2022
Last updated
08/22/2022
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