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General NPI Number Information
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NPI Number | 1376602581
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Entity Type | Organization
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Legal Business Name | HEALING GARDENS HEALTH CENTER
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 315 CANYON AVE SUITE1
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City | FORT COLLINS
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State | CO
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Zip | 80521-2677
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Country | US
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Telephone | 970-472-6789
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Fax | 970-472-6799
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Provider Business Mailing Address
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Address Line | 315 CANYON AVENUE SUITE1
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City | FORT COLLINS
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State | CO
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Zip | 80521-2677
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Country | US
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Telephone | 970-472-6789
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Fax | 970-472-6799
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACQUELINE C FIELDS
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Credential | MD
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Telephone | 970-472-6789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 33698
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License Number State | CO
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