Provider Demographics
NPI:1225784937
Name:MAGNOLIA NATURAL HEALING LLC
Entity Type:Organization
Organization Name:MAGNOLIA NATURAL HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:CORRINA
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:541-550-0847
Mailing Address - Street 1:PO BOX 8629
Mailing Address - Street 2:C/O LEA WHITE
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-8629
Mailing Address - Country:US
Mailing Address - Phone:978-270-3879
Mailing Address - Fax:
Practice Address - Street 1:1554 NE 4TH STREET
Practice Address - Street 2:MIDTOWN WELLNESS CENTER
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:541-550-0847
Practice Address - Fax:541-209-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty