Provider Demographics
NPI:1053184812
Name:NATURAL WELLNESS ADVANTAGE, LLC
Entity type:Organization
Organization Name:NATURAL WELLNESS ADVANTAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:320-282-8074
Mailing Address - Street 1:25424 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-9714
Mailing Address - Country:US
Mailing Address - Phone:320-282-8074
Mailing Address - Fax:
Practice Address - Street 1:215 1ST ST S
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-4550
Practice Address - Country:US
Practice Address - Phone:320-282-8074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty