Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | OR |
NPI | 1053843912 |
---|---|
Provider Name | Kalli Keddie |
First Address | Newberg, OR 97132-4018 |
Second Address | Mcminnville, OR 97128-2712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2017 |
Last Update Date | 30/03/2017 |