NPIMap

Organization Active NPI

Magnolia Naturopathic Medicine, LLC

  • Medical Specialty Clinic/Center
  • Puyallup, WA
National Provider Identifier
1043695547
Registry record updated Jul 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
NT60524427 Issued in WA
Legal business name
MAGNOLIA NATUROPATHIC MEDICINE, LLC
Practice address
803 39TH Ave SW Ste F
Puyallup, WA 98373-3692
Phone
(253) 848-1055
Fax
(253) 848-5533
NPI assigned
Jul 25, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Laura Elayne Firetag, NDNPI 1235537234
Title
Naturopathic Physician
Phone
(843) 209-3966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X NT60524427 WA Primary

Addresses

Primary practice location

803 39TH Ave SW Ste F
Puyallup, WA 98373-3692

Mailing address

803 39TH Ave SW Ste F
Puyallup, WA 98373-3692
Phone (253) 848-1055

Other identifiers 1

IdentifierTypeStateIssuer
1235537234OtherWAPROVIDER NPI

Other names 1

  • Magnolia Naturopathic Medicine Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437782400000",
    "number": "1043695547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 39TH AVE SW STE F",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733692",
            "telephone_number": "253-848-1055",
            "fax_number": "253-848-5533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 39TH AVE SW STE F",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733692",
            "telephone_number": "253-848-1055",
            "fax_number": "253-848-5533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA NATUROPATHIC MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-25",
        "last_updated": "2015-07-25",
        "status": "A",
        "authorized_official_last_name": "FIRETAG",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "ELAYNE",
        "authorized_official_title_or_position": "NATUROPATHIC PHYSICIAN",
        "authorized_official_telephone_number": "843-209-3966",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ND"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "WA",
            "license": "NT60524427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NPI",
            "identifier": "1235537234",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Naturopathic Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.