Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1524 | OR |
NPI | 1083749709 |
---|---|
Provider Name | Dr. Lindsay Marie Fontenot |
First Address | Portland, OR 97211-2625 |
Second Address | Portland, OR 97232-1586 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 26/08/2019 |