Provider Demographics
NPI:1841609575
Name:SANTE WELLNESS LLC
Entity Type:Organization
Organization Name:SANTE WELLNESS LLC
Other - Org Name:SANTE AESTHETICS & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCEA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:971-407-3066
Mailing Address - Street 1:210 NW 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2151
Mailing Address - Country:US
Mailing Address - Phone:971-407-3066
Mailing Address - Fax:971-407-3067
Practice Address - Street 1:210 NW 17TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2151
Practice Address - Country:US
Practice Address - Phone:971-407-3066
Practice Address - Fax:971-407-3067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1582175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty