Provider Demographics
NPI:1194438952
Name:WHITE OWL HOLISTIC
Entity type:Organization
Organization Name:WHITE OWL HOLISTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERT. NATURAL HEALTH PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIARRUSSO-KRABACHER
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED, CNHP
Authorized Official - Phone:315-663-5787
Mailing Address - Street 1:612 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-2321
Mailing Address - Country:US
Mailing Address - Phone:315-663-5787
Mailing Address - Fax:
Practice Address - Street 1:612 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-2321
Practice Address - Country:US
Practice Address - Phone:315-663-5787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty