1225860711 NPI number — GREEN LOTUS HEALTH & WELLNESS, PLLC

Table of content: (NPI 1225860711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225860711 NPI number — GREEN LOTUS HEALTH & WELLNESS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREEN LOTUS HEALTH & WELLNESS, PLLC
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:
1225860711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 NW 5TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUYMON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73942-4204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-338-7462
Provider Business Mailing Address Fax Number:
855-538-3350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 S BLACKHAWK ST STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80014-1475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-338-7462
Provider Business Practice Location Address Fax Number:
855-538-3350
Provider Enumeration Date:
08/14/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
MARLENE
Authorized Official Middle Name:
ANGELA
Authorized Official Title or Position:
APRN-CNP/OWNER
Authorized Official Telephone Number:
580-338-7462

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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