Healthcare Provider Details

I. General information

NPI: 1437455656
Provider Name (Legal Business Name): FIVE RINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 NE 63RD ST 259
VANCOUVER WA
98661-1980
US

IV. Provider business mailing address

6715 NE 63RD ST 259
VANCOUVER WA
98661-1980
US

V. Phone/Fax

Practice location:
  • Phone: 360-719-1744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: M LANDIS
Title or Position: DIRECTOR
Credential:
Phone: 360-719-1744