Healthcare Provider Details

I. General information

NPI: 1356110126
Provider Name (Legal Business Name): NUWA INTEGRATIVE WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E POWELL BLVD
GRESHAM OR
97030-7605
US

IV. Provider business mailing address

635 SE PARK DR
GRESHAM OR
97080-7825
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-1500
  • Fax:
Mailing address:
  • Phone: 608-769-5135
  • Fax: 503-893-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE EASTIN
Title or Position: OWNER
Credential: LAC
Phone: 608-769-5135