Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 2100026 | KS |
NPI | 1083904577 |
---|---|
Provider Name | Laurell Matthews |
First Address | Fayetteville, AR 72704-5485 |
Second Address | Fayetteville, AR 72704-5485 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2011 |
Last Update Date | 18/04/2011 |