Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1388 | OR |
NPI | 1053402693 |
---|---|
Provider Name | Dr. Kelley Renee Reis |
First Address | Hillsboro, OR 97123-4129 |
Second Address | Hillsboro, OR 97123-4129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022973 | (05) | OR |