Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 1138 | OR |
Y | 175F00000X | Naturopath | NT00001485 | WA |
NPI | 1114969847 |
---|---|
Provider Name | Dr. Meredith Jill Distante |
First Address | Camas, WA 98607 |
Second Address | Camas, WA 98607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 16/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
229268 | OMAP PROVIDER NUMBER (01) | OR |