Provider Demographics
NPI:1720969736
Name:REWILD NATURAL HEALTH CLINIC
Entity type:Organization
Organization Name:REWILD NATURAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:RACHAEL
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:608-768-2250
Mailing Address - Street 1:2560 E MAIN ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-9472
Mailing Address - Country:US
Mailing Address - Phone:608-768-2250
Mailing Address - Fax:608-768-2251
Practice Address - Street 1:2560 E MAIN ST STE 2A
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-9472
Practice Address - Country:US
Practice Address - Phone:608-768-2250
Practice Address - Fax:608-768-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center