Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1979 | OR |
NPI | 1063849073 |
---|---|
Provider Name | Dr. Andrea Trelease Williams Del-Olmo |
First Address | Portland, OR 97215-1801 |
Second Address | Portland, OR 97214-6307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2013 |
Last Update Date | 01/08/2014 |