Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 0688 | OR |
NPI | 1073690806 |
---|---|
Provider Name | Dr. Edythe Marsh Vickers |
First Address | Portland, OR 97210-3022 |
Second Address | Portland, OR 97210-3022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 13/04/2008 |