=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144877671
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANIFEST MEDICINE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2019
-----------------------------------------------------
Last Update Date | 08/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | THE HEALING ART CENTER 453 N BEACH RD
-----------------------------------------------------
City | EASTSOUND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98245-8927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-437-5683
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 22
-----------------------------------------------------
City | WALDRON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98297-0022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | APRIL HINSBERGER
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 253-266-0988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------