Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 11-1231 | AZ |
N | 175F00000X | Naturopath | 1650 | OR |
NPI | 1013161181 |
---|---|
Provider Name | Dr. Ryan Lee Sweeney |
First Address | Flagstaff, AZ 86001 |
Second Address | Portland, OR 97206-1408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2008 |
Last Update Date | 26/07/2011 |