Provider Demographics
NPI:1477115962
Name:WILDFLOWER NATURAL MEDICINE
Entity Type:Organization
Organization Name:WILDFLOWER NATURAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WARD-SELINGER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-974-4813
Mailing Address - Street 1:132 SW CROWELL WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1178
Mailing Address - Country:US
Mailing Address - Phone:503-974-4813
Mailing Address - Fax:503-662-7574
Practice Address - Street 1:132 SW CROWELL WAY STE 101
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1178
Practice Address - Country:US
Practice Address - Phone:503-974-4813
Practice Address - Fax:503-662-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5006543767Medicaid
OR500654367Medicaid