1518213149 NPI number — BONNIE JEAN SKAKEL

Table of content: (NPI 1518213149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518213149 NPI number — BONNIE JEAN SKAKEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BONNIE JEAN SKAKEL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THREE SISTERS NATURAL HEALTH, LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518213149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 SE 7TH AVE UNIT 14100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97293-0815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-639-9056
Provider Business Mailing Address Fax Number:
541-639-3590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2955 N HWY 97 STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97703-7559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-639-9056
Provider Business Practice Location Address Fax Number:
541-639-3590
Provider Enumeration Date:
08/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SKAKEL
Authorized Official First Name:
BONNIE
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
NATUROPATHIC DOCTOR & ACUPUNCTURIST
Authorized Official Telephone Number:
541-639-9056

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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