Provider Demographics
NPI:1336486489
Name:NATURAL MEDICINES & FAMILY PRACTICE
Entity Type:Organization
Organization Name:NATURAL MEDICINES & FAMILY PRACTICE
Other - Org Name:NATURAL MEDICINES AND FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:360-357-8054
Mailing Address - Street 1:1315 RUDDELL RD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5701
Mailing Address - Country:US
Mailing Address - Phone:360-357-8054
Mailing Address - Fax:
Practice Address - Street 1:1315 RUDDELL RD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5701
Practice Address - Country:US
Practice Address - Phone:360-357-8054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA1001318363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty