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General NPI Number Information
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NPI Number | 1902159247
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Entity Type | Organization
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Legal Business Name | AN SHEN WELLNESS WELLNESS
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 1906 BROADWAY ST
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City | VANCOUVER
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State | WA
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Zip | 98663-3325
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Country | US
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Telephone | 360-694-7668
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Fax |
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Provider Business Mailing Address
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Address Line | 1906 BROADWAY ST
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City | VANCOUVER
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State | WA
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Zip | 98663-3325
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Country | US
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Telephone | 360-694-7668
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MICHAELE A GEOGHEGAN
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Credential | MSTOM, LAC
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Telephone | 360-694-5425
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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 | AC00002081
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License Number State | WA
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