Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 4021 | OR |
N | 225700000X | Massage Therapist | 19440 | OR |
NPI | 1053658096 |
---|---|
Provider Name | Lindsay Anne-Marie Wilkinson |
First Address | Portland, OR 97218-3716 |
Second Address | Portland, OR 97210-3400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2013 |
Last Update Date | 05/10/2016 |