1023859352 NPI number — BRIGHT AURA THERAPY AND WELLNESS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023859352 NPI number — BRIGHT AURA THERAPY AND WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHT AURA THERAPY AND WELLNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023859352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10188 76TH ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49302-9640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-437-2197
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2040 RAYBROOK ST SE STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49546-7718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-437-2197
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FRIDLEY
Authorized Official First Name:
STACIA
Authorized Official Middle Name:
LEA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
616-437-2197

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)