MEDICARE: LAURA BLEVINS ND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	3053	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043680796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA BLEVINS ND

Provider Business Mailing Address
First Line	:	4036 S 6TH ST STE 2
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4750
Country	:	US
Telephone Number	:	541-851-9320
Fax Number	:	541-851-9322

Provider Business Practice Location Address
First Line	:	4036 S 6TH ST STE 2
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4750
Country	:	US
Telephone Number	:	541-851-9320
Fax Number	:	541-851-9322

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	07/09/2018

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