Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 4204 | OR |
NPI | 1104391929 |
---|---|
Provider Name | Adrianne Sebastian |
First Address | Portland, OR 97205-1124 |
Second Address | Portland, OR 97205-1124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2018 |
Last Update Date | 11/06/2019 |