MEDICARE: WILDFLOWER NATURAL MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist
2	175F00000X	Naturopath

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477115962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILDFLOWER NATURAL MEDICINE

Provider Business Mailing Address
First Line	:	132 SW CROWELL WAY STE 101
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-1178
Country	:	US
Telephone Number	:	503-974-4813
Fax Number	:	503-662-7574

Provider Business Practice Location Address
First Line	:	132 SW CROWELL WAY STE 101
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-1178
Country	:	US
Telephone Number	:	503-974-4813
Fax Number	:	503-662-7574

Authorized Official
Title or Position	:	OWNER
Name	:	LAUREN JEAN WARD-SELINGER
Credential	:	ND
Telephone Number	:	503-974-4813

Provider Enumeration Date	:	07/03/2019
Last Update Date	:	03/16/2023

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Directions to “WILDFLOWER NATURAL MEDICINE ” Practice Location

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