Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 2053 | OR |
NPI | 1033513916 |
---|---|
Provider Name | Dr. Angela Potter |
First Address | Portland, OR 97212-2356 |
Second Address | Portland, OR 97232-1512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2014 |
Last Update Date | 21/10/2014 |