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General NPI Number Information
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NPI Number | 1255145819
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Entity Type | Organization
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Legal Business Name | EVERGREEN HOLISTIC HEALING LLC
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 415 N FRONT ST
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City | SPOONER
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State | WI
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Zip | 54801-1403
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Country | US
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Telephone | 715-544-8964
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Fax |
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Provider Business Mailing Address
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Address Line | 415 N FRONT ST
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City | SPOONER
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State | WI
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Zip | 54801-1403
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Country | US
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Telephone | 715-544-8964
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | PARKER HEWES
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Credential |
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Telephone | 715-544-8964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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