Provider Demographics
NPI:1558802074
Name:WANDERING HEART HEALING ARTS LLC
Entity Type:Organization
Organization Name:WANDERING HEART HEALING ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WREGE
Authorized Official - Suffix:
Authorized Official - Credentials:ND, MSOM, LAC
Authorized Official - Phone:541-515-9669
Mailing Address - Street 1:6225 N ALBINA AVE
Mailing Address - Street 2:#2
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-1867
Mailing Address - Country:US
Mailing Address - Phone:541-515-9669
Mailing Address - Fax:
Practice Address - Street 1:6225 N ALBINA AVE
Practice Address - Street 2:#2
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-1867
Practice Address - Country:US
Practice Address - Phone:541-515-9669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty