Organization
FULL BLOOM NATURAL MEDICINE, LLC
Active
Other names
Mary J Boucher, ND, Full Bloom Natural Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MARY BOUCHER ND (DR.)
(541) 224-6738
Entity
Organization
Contact information
Practice address
922 NW CIRCLE BLVD STE 180, CORVALLIS, OR 97330-1483
(541) 224-6738
Mailing address
922 NW CIRCLE BLVD STE 180, CORVALLIS, OR 97330-1483
(541) 224-6738
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
06/14/2019
Last updated
12/09/2019
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