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General NPI Number Information
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NPI Number | 1154137230
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Entity Type | Organization
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Legal Business Name | NORTH COUNTRY SANCTUARY LLC
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 15657 COUNTY HIGHWAY B
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City | HAYWARD
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State | WI
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Zip | 54843-2680
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Country | US
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Telephone | 715-798-3330
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 494
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City | HAYWARD
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State | WI
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Zip | 54843-0494
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Country | US
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Telephone | 715-798-3330
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | ANNA JAQUITH
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Credential | LAC, LMT
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Telephone | 715-798-3330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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