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General NPI Number Information
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NPI Number | 1770855777
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Entity Type | Organization
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Legal Business Name | WINTZER ACUPUNCTURE LLC
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 430 NE CEDAR ST
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City | CAMAS
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State | WA
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Zip | 98607-2144
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Country | US
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Telephone | 360-851-4268
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Fax | 844-244-8288
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Provider Business Mailing Address
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Address Line | 430 NE CEDAR ST
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City | CAMAS
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State | WA
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Zip | 98607-2144
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Country | US
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Telephone | 360-851-4268
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Fax | 844-244-8288
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Authorized Official
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Title or Position | EAST ASIAN MEDICINE PRACTITIONER
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Name | DIANE SUSAN WINTZER
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Credential | EAMP
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Telephone | 360-851-4268
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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 | AC60055845
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License Number State | WA
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