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Organization
PACIFIC NORTHWEST WELLNESS LLC
Active
Organization
PACIFIC NORTHWEST WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRISCILLA MYCO (OWNER)
(719) 266-0421
Entity
Organization
Contact information
Practice address
106 E 16TH AVE, EUGENE, OR 97401-4033
(971) 266-0421
Mailing address
106 E 16TH AVE, EUGENE, OR 97401-4033
(971) 266-0421
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346542503
—
OR
Enumeration date
05/16/2019
Last updated
06/11/2019
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