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General NPI Number Information
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NPI Number | 1356110126
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Entity Type | Organization
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Legal Business Name | NUWA INTEGRATIVE WELLNESS, LLC
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Dates
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Enumeration Date | 12/21/2023
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 223 E POWELL BLVD
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City | GRESHAM
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State | OR
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Zip | 97030-7605
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Country | US
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Telephone | 503-667-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 635 SE PARK DR
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City | GRESHAM
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State | OR
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Zip | 97080-7825
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Country | US
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Telephone | 608-769-5135
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Fax | 503-893-3045
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE EASTIN
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Credential | LAC
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Telephone | 608-769-5135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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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 | 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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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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