Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 4210 | OR |
NPI | 1003381922 |
---|---|
Provider Name | Nicole Michelle Silva |
First Address | Portland, OR 97206-4761 |
Second Address | Portland, OR 97202-5615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2018 |
Last Update Date | 07/10/2018 |