Healthcare Provider Details

I. General information

NPI: 1023885191
Provider Name (Legal Business Name): HOMEOPATHIC WEIGHT MANAGEMENT LLC/EVOKE HEALING SPACE AND SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 NW ARIZONA AVE
BEND OR
97703-3260
US

IV. Provider business mailing address

634 NW ARIZONA AVE
BEND OR
97703-3260
US

V. Phone/Fax

Practice location:
  • Phone: 541-797-6744
  • Fax:
Mailing address:
  • Phone: 541-797-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DONNA KERLEY
Title or Position: OWNER
Credential:
Phone: 541-797-6744