Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 4167 | OR |
NPI | 1104307867 |
---|---|
Provider Name | Kelsey Stang |
First Address | Portland, OR 97236-2249 |
Second Address | Portland, OR 97206-1303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2018 |
Last Update Date | 22/08/2018 |