Healthcare Provider Details

I. General information

NPI: 1639432271
Provider Name (Legal Business Name): HEATHER LYN WOJSLAW NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7629 E PINNACLE PEAK RD STE 114
SCOTTSDALE AZ
85255-6290
US

IV. Provider business mailing address

7558 W THUNDERBIRD RD STE 1-460
PEORIA AZ
85381-6080
US

V. Phone/Fax

Practice location:
  • Phone: 480-502-9487
  • Fax: 855-313-5053
Mailing address:
  • Phone: 480-502-9487
  • Fax: 855-313-5053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number12-1314
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: