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NPI Code Detail

MEDICARE: NOURISHING LIFE CHINESE MEDICINE CLINIC LLC

MEDICARE: NOURISHING LIFE CHINESE MEDICINE CLINIC LLC
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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1861260143
Entity Type Code : Organization
Provider Name (Legal Business Name) : NOURISHING LIFE CHINESE MEDICINE CLINIC LLC
Provider Business Mailing Address
First Line : 1334 LAWRENCE ST
Second Line :
City : PORT TOWNSEND
State : WA
Zip : 98368-6529
Country : US
Telephone Number : 360-379-6798
Fax Number :
Provider Business Practice Location Address
First Line : 1334 LAWRENCE ST
Second Line :
City : PORT TOWNSEND
State : WA
Zip : 98368-6529
Country : US
Telephone Number : 360-379-6798
Fax Number :
Authorized Official
Title or Position : DOCTOR OF EAST ASIAN MEDICINE
Name : DR. ALLISON JEAN MUMA
Credential : DSOM LAC
Telephone Number : 360-379-6798
Provider Enumeration Date : 12/15/2023
Last Update Date : 12/15/2023

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