Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 2021 | OR |
NPI | 1124448873 |
---|---|
Provider Name | Dr. Jelena Blackburn |
First Address | Eugene, OR 97401-7106 |
Second Address | Eugene, OR 97401-6003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2014 |
Last Update Date | 01/02/2016 |