Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 4253 | OR |
NPI | 1093346595 |
---|---|
Provider Name | Corina Doctrine |
First Address | Beaverton, OR 97005-3769 |
Second Address | Portland, OR 97223-6692 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2020 |
Last Update Date | 03/02/2020 |