Wild Hearts Wellness LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC153455 Issued in OR

Legal business name

WILD HEARTS WELLNESS LLC

Practice address

4423 NE Tillamook St
Portland, OR 97213-1317

Phone

(971) 400-6063

NPI assigned

Dec 22, 2016

Last updated

Dec 22, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Maura Dawgert, L.AC.

Title

Owner, Acupuncturist

Phone

(971) 400-6063

Specialties & licenses 1

Addresses

Other names 1

• Maura Dawgert, L.Ac Other name

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

{
    "created_epoch": "1482364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482364800000",
    "number": "1063957330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4114 NE 74TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972183633",
            "telephone_number": "971-400-6063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4423 NE TILLAMOOK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972131317",
            "telephone_number": "971-400-6063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD HEARTS WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-22",
        "last_updated": "2016-12-22",
        "status": "A",
        "authorized_official_last_name": "DAWGERT",
        "authorized_official_first_name": "MAURA",
        "authorized_official_title_or_position": "OWNER, ACUPUNCTURIST",
        "authorized_official_telephone_number": "971-400-6063",
        "authorized_official_credential": "L.AC."
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC153455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maura Dawgert, L.Ac",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Acupuncturist in Portland, OR
• Providers in Portland, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; 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.