Organization
AKASHA WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE LENCE MS, RDN, LDN (CHIEF EXECUTIVE OFFICER)
(618) 889-9570
Entity
Organization
Contact information
Practice address
350 ZACH LN, OZARK, IL 62972-1119
(618) 889-9570
Mailing address
350 ZACH LN, OZARK, IL 62972-1119
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
164.006153
IL
Other
Enumeration date
06/25/2015
Last updated
06/25/2015
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