=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013678242
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | URBAN PLANTATIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2022
-----------------------------------------------------
Last Update Date | 10/31/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5759 SE FEDERAL HWY
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34997-8545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-837-0810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5831 SE RIVERBOAT DR # 413
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34997-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-837-0810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | D.O.M.
-----------------------------------------------------
Name | DR. HEATHER JEANINE WALDEN
-----------------------------------------------------
Credential | ORIENTAL MEDICINE
-----------------------------------------------------
Telephone | 772-837-0810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------