Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1471 | OR |
NPI | 1154480408 |
---|---|
Provider Name | Dr. Lissa Michelle Mcniel |
First Address | Jacksonville, OR 97530 |
Second Address | Medford, OR 97501-8922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |