Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 2017 | OR |
NPI | 1043633217 |
---|---|
Provider Name | Dr. Karen Renee Peterson |
First Address | Portland, OR 97206-7626 |
Second Address | Portland, OR 97206-7626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2014 |
Last Update Date | 24/01/2014 |