Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 4171 | OR |
NPI | 1053895615 |
---|---|
Provider Name | Dr. Emma Michelle Neiworth Petshow |
First Address | Happy Valley, OR 97086-8738 |
Second Address | Portland, OR 97239-4628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2018 |
Last Update Date | 16/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500767312 | (05) | OR |