Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1971 | OR |
NPI | 1013344068 |
---|---|
Provider Name | Dr. Jenna Wilsoncrain |
First Address | Portland, OR 97201-4858 |
Second Address | Portland, OR 97201-4858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2013 |
Last Update Date | 06/10/2013 |