Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 871 | OR |
NPI | 1114066271 |
---|---|
Provider Name | Dr. Audrey Lee Bergsma |
First Address | Portland, OR 97201-5003 |
Second Address | Portland, OR 97201-5003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |