Provider Demographics
NPI:1144749656
Name:NATURAL LIFE INTEGRATIVE HEALTH
Entity Type:Organization
Organization Name:NATURAL LIFE INTEGRATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR, TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ELAYNE
Authorized Official - Last Name:FIRETAG
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:843-209-3966
Mailing Address - Street 1:102 23RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4501
Mailing Address - Country:US
Mailing Address - Phone:253-268-2170
Mailing Address - Fax:253-268-0658
Practice Address - Street 1:102 23RD AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4501
Practice Address - Country:US
Practice Address - Phone:253-268-2170
Practice Address - Fax:253-268-0658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60524427175F00000X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2047746Medicaid