Provider Demographics
NPI:1407337074
Name:BOUNTIFUL HEALTH FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:BOUNTIFUL HEALTH FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:BOWDEN
Authorized Official - Last Name:GREINER
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:503-360-6694
Mailing Address - Street 1:170 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3729
Mailing Address - Country:US
Mailing Address - Phone:503-266-2997
Mailing Address - Fax:888-975-8027
Practice Address - Street 1:170 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3729
Practice Address - Country:US
Practice Address - Phone:503-360-6694
Practice Address - Fax:888-975-8027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOUNTIFUL HEALTH FAMILY MEDICINE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2041175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty