Healthcare Provider Details

I. General information

NPI: 1982771812
Provider Name (Legal Business Name): NORTHWEST WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 NE 76TH ST
VANCOUVER WA
98661-1357
US

IV. Provider business mailing address

5115 NE 76TH ST
VANCOUVER WA
98661-1357
US

V. Phone/Fax

Practice location:
  • Phone: 888-837-8567
  • Fax:
Mailing address:
  • Phone: 888-837-8567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number50F0968535
License Number StateOR

VIII. Authorized Official

Name: DR. DAVID OGLE
Title or Position: DIRECTOR
Credential: MD
Phone: 888-837-8567