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General NPI Number Information
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NPI Number | 1013514959
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Entity Type | Organization
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Legal Business Name | FUTURE HOPE WELLNESS LLC
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 1805 CHINCHALLA WAY
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City | KLAMATH FALLS
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State | OR
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Zip | 97603-5234
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Country | US
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Telephone | 541-892-1248
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Fax |
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Provider Business Mailing Address
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Address Line | 1805 CHINCHALLA WAY
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City | KLAMATH FALLS
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State | OR
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Zip | 97603-5234
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Country | US
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Telephone | 541-892-1248
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SHAWNA ROSS
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Credential | BSNS
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Telephone | 541-884-3070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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