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General NPI Number Information
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NPI Number | 1730638339
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Entity Type | Organization
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Legal Business Name | NOURISHING QI LLC SERIES A
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Dates
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Enumeration Date | 09/25/2016
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Last Update Date | 09/25/2016
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Provider Practice Location Address
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Address Line | 900 CHICAGO AVE SUITE 100
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City | EVANSTON
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State | IL
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Zip | 60202-1872
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Country | US
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Telephone | 773-351-3352
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Fax |
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Provider Business Mailing Address
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Address Line | 900 CHICAGO AVE SUITE 100
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City | EVANSTON
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State | IL
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Zip | 60202-1872
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Country | US
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Telephone | 773-351-3352
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORI HOWELL
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Credential | L.AC., DAOM
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Telephone | 773-351-3352
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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 | 198000594
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License Number State | IL
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