MEDICARE: WOOTEN NATUROPATHIC PLC

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	05902	AZ

General Provider Information

NPI Number	:	1538587985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOOTEN NATUROPATHIC PLC

Provider Business Mailing Address
First Line	:	3714 E INDIAN SCHOOL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3714 E INDIAN SCHOOL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5157
Country	:	US
Telephone Number	:	602-840-4112
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRACY WOOTEN
Credential	:	ND
Telephone Number	:	602-840-4112

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	04/02/2014

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