Full Bloom Natural Medicine, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

FULL BLOOM NATURAL MEDICINE, LLC

Practice address

922 NW Circle Blvd Ste 180
Corvallis, OR 97330-1483

Phone

(541) 224-6738

NPI assigned

Jun 14, 2019

Organization subpart

No

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

Authorized official

Name

Mary Boucher, NDNPI 1760020200

Title

Dr.

Phone

(541) 224-6738

Specialties & licenses 1

Addresses

Other names 2

• Full Bloom Natural Medicine Doing business as
• Mary J Boucher, ND Former legal business name

Locations

Practitioners 1

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

• Mary J Boucher, ND

  • Naturopath
  • Corvallis, OR
  • NPI 1760020200
  NPD (past) Authorized official

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

{
    "created_epoch": "1560470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575849600000",
    "number": "1871153585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "922 NW CIRCLE BLVD STE 180",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973301483",
            "telephone_number": "541-224-6738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "922 NW CIRCLE BLVD STE 180",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973301483",
            "telephone_number": "541-224-6738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL BLOOM NATURAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-14",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A",
        "authorized_official_last_name": "BOUCHER",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "DR.",
        "authorized_official_telephone_number": "541-224-6738",
        "authorized_official_credential": "ND"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Full Bloom Natural Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Full Bloom Natural Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mary J Boucher, ND",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Rowan Fry
• Alejandro Fuentes Bautista, DO
• Vikki Fuhrman
• Stacie Marie Fulcher, PA-C
• Fulcrum Osteopathic, LLC
• Mino Fuller
• Chantell N Fulton
• Tara Fulton
• Joshua A Funk, DPT
• Mira Funk

• Primary Care Clinic/Center in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Primary Care Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2019; 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.