Provider Demographics
NPI:1144022658
Name:NATURE BREAK WELLNESS LLC
Entity type:Organization
Organization Name:NATURE BREAK WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:GALL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:320-630-9116
Mailing Address - Street 1:35294 LOGAN LN
Mailing Address - Street 2:
Mailing Address - City:HILLMAN
Mailing Address - State:MN
Mailing Address - Zip Code:56338-2445
Mailing Address - Country:US
Mailing Address - Phone:320-630-9116
Mailing Address - Fax:
Practice Address - Street 1:35294 LOGAN LN
Practice Address - Street 2:
Practice Address - City:HILLMAN
Practice Address - State:MN
Practice Address - Zip Code:56338-2445
Practice Address - Country:US
Practice Address - Phone:320-630-9116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No251J00000XAgenciesNursing Care
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service