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1043695547 NPI number — MAGNOLIA NATUROPATHIC MEDICINE, LLC

NPI Number: 1043695547
Health Care Provider/Practitioner: MAGNOLIA NATUROPATHIC MEDICINE, LLC

Information about “1043695547” NPI (MAGNOLIA NATUROPATHIC MEDICINE, LLC) exists in 1043695547 in HTML format HTML  |  1043695547 in plain Text format TXT  |  1043695547 in PDF (Portable Document Format) PDF  |  1043695547 in an XML format XML  formats.

NPI Number : 1043695547 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043695547",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MAGNOLIA NATUROPATHIC MEDICINE, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "803 39TH AVE SW STE F",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PUYALLUP",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98373-3692",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "253-848-1055",
    "MailingAddressFaxNumber": "253-848-5533",
    "FirstLinePracticeLocationAddress": "803 39TH AVE SW STE F",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PUYALLUP",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98373-3692",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "253-848-1055",
    "PracticeLocationAddressFaxNumber": "253-848-5533",
    "EnumerationDate": "07/25/2015",
    "LastUpdateDate": "07/25/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FIRETAG",
    "AuthorizedOfficialFirstName": "LAURA",
    "AuthorizedOfficialMiddleName": "ELAYNE",
    "AuthorizedOfficialTitle": "NATUROPATHIC PHYSICIAN",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "ND",
    "AuthorizedOfficialTelephoneNumber": "843-209-3966",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM2500X",
        "TaxonomyName": "Medical Specialty Clinic/Center",
        "LicenseNumber": "NT60524427",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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