=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427448935
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IN LIGHT FOR LIFE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2015
-----------------------------------------------------
Last Update Date | 02/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 E 16TH ST
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98663-3409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-326-3264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 E 16TH ST
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98663-3409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-326-3264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | EDNA NESS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-326-3264
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | NT.00001291
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------