1609742527 NPI number — YELLOW LOTUS CLINICAL SERVICES FOR HEALING & WELLNESS PLLC

Table of content: GARY DUANE LUNDGREN RPH (NPI 1518259043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609742527 NPI number — YELLOW LOTUS CLINICAL SERVICES FOR HEALING & WELLNESS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YELLOW LOTUS CLINICAL SERVICES FOR HEALING & 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:
1609742527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2628 WINDING CREEK TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PORT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34289-2408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-278-8085
Provider Business Mailing Address Fax Number:
941-866-3595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2628 WINDING CREEK TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PORT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34289-2408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-278-8085
Provider Business Practice Location Address Fax Number:
941-866-3595
Provider Enumeration Date:
10/16/2025

Additional Information

Authorized Official

Authorized Official Last Name:
LENNING
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/CLINICAL DIRECTOR
Authorized Official Telephone Number:
989-560-5698

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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