Provider Demographics
NPI:1942645346
Name:A WELLSPRING OF NATURAL HEALTH
Entity Type:Organization
Organization Name:A WELLSPRING OF NATURAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-526-0397
Mailing Address - Street 1:4720 SW WATSON AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-0511
Mailing Address - Country:US
Mailing Address - Phone:503-526-0397
Mailing Address - Fax:503-643-4633
Practice Address - Street 1:4720 SW WATSON AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0511
Practice Address - Country:US
Practice Address - Phone:503-526-0397
Practice Address - Fax:503-643-4633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR95171100000X
OR696175F00000X
OR753175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty