Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 3053 | OR |
NPI | 1043680796 |
---|---|
Provider Name | Laura Blevins |
First Address | Klamath Falls, OR 97603-4750 |
Second Address | Klamath Falls, OR 97603-4750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2015 |
Last Update Date | 09/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500694147 | (05) | OR |