Healthcare Provider Details

I. General information

NPI: 1740724194
Provider Name (Legal Business Name): MARY ANN MCGLAUFLIN ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 GARVORD ST
LEBANON OR
97355-3804
US

IV. Provider business mailing address

835 GARVORD ST
LEBANON OR
97355-3804
US

V. Phone/Fax

Practice location:
  • Phone: 503-537-7862
  • Fax:
Mailing address:
  • Phone: 503-537-7862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1047R
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: