The Wild Daughters

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

THE WILD DAUGHTERS

Practice address

509 Michigan Ave
Holland, MI 49423-4750

Phone

(616) 710-1851

NPI assigned

Apr 19, 2021

Last updated

Apr 19, 2021By 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

Miss Madison K Barense, LMT

Title

Owner

Phone

(616) 710-1851

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1618790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618790400000",
    "number": "1750962965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1041 E 16TH ST APT 207",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494239173",
            "telephone_number": "616-312-3609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 MICHIGAN AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234750",
            "telephone_number": "616-710-1851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WILD DAUGHTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-19",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A",
        "authorized_official_last_name": "BARENSE",
        "authorized_official_first_name": "MADISON",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-710-1851",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Service Clinic/Center in Holland, MI
• Providers in Holland, MI by specialty
• Health Service Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; 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.