=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811345366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWERING PINES ACUPUNCTURE AND ORIENTAL MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2016
-----------------------------------------------------
Last Update Date | 05/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N6W27539 NORTHVIEW RD
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53188-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-549-2349
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 316 OAKTON AVE
-----------------------------------------------------
City | PEWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53072-3540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-549-2349
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ANGELA AUKOFER-PARKER
-----------------------------------------------------
Credential | MSOM, LMT
-----------------------------------------------------
Telephone | 262-549-2349
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------