Healthcare Provider Details

I. General information

NPI: 1407073489
Provider Name (Legal Business Name): TAMARA ANN MACDONALD ND LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 PEARL RD SUITE B
BRUNSWICK OH
44212
US

IV. Provider business mailing address

1814 PEARL RD SUITE B
BRUNSWICK OH
44212
US

V. Phone/Fax

Practice location:
  • Phone: 330-460-5155
  • Fax: 330-460-5155
Mailing address:
  • Phone: 330-460-5155
  • Fax: 330-460-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number126
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT1179
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: