Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 3098 | OR |
NPI | 1104278589 |
---|---|
Provider Name | Rachel Clark |
First Address | Portland, OR 97205-2124 |
Second Address | Portland, OR 97205-2124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2016 |
Last Update Date | 18/09/2016 |