Provider Demographics
NPI:1649637851
Name:PRANAVIS LLC
Entity type:Organization
Organization Name:PRANAVIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:OLT
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:253-442-4901
Mailing Address - Street 1:1011 S L ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4002
Mailing Address - Country:US
Mailing Address - Phone:253-442-4901
Mailing Address - Fax:844-225-2912
Practice Address - Street 1:1011 S L ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4002
Practice Address - Country:US
Practice Address - Phone:253-442-4901
Practice Address - Fax:844-225-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001066175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty