Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 19-1784 | AZ |
Y | 175F00000X | Naturopath | 4255 | OR |
NPI | 1003377789 |
---|---|
Provider Name | Dr. Rachael Amy O'connell |
First Address | Portland, OR 97225-5105 |
Second Address | Portland, OR 97225-5105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2019 |
Last Update Date | 10/02/2022 |