Provider Demographics
NPI:1265723217
Name:MADRONA NATUROPATHIC HEALTHCARE, INC
Entity type:Organization
Organization Name:MADRONA NATUROPATHIC HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:STAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:ND, RD
Authorized Official - Phone:651-233-0608
Mailing Address - Street 1:161 CHESTNUT ST # 6
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1302
Mailing Address - Country:US
Mailing Address - Phone:651-233-0608
Mailing Address - Fax:925-634-4091
Practice Address - Street 1:2221 BALFOUR RD
Practice Address - Street 2:STE D
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4932
Practice Address - Country:US
Practice Address - Phone:651-233-0608
Practice Address - Fax:925-634-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1008261QP2300X
CA225261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care