Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 4098 | OR |
NPI | 1124531215 |
---|---|
Provider Name | Node Allen Smith |
First Address | Beaverton, OR 97008-5499 |
Second Address | Portland, OR 97209-3907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2017 |
Last Update Date | 17/03/2018 |