Organization
PROACTIVE NUTRITION & WELLNESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW WINQUIST RD/LDN (PRESIDENT)
(727) 409-0016
Entity
Organization
Contact information
Practice address
1455 LAUREL AVE, COOS BAY, OR 97420-2167
(727) 409-0016
Mailing address
1455 LAUREL AVE, COOS BAY, OR 97420-2167
(727) 409-0016
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
05/21/2020
Last updated
05/21/2020
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