Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1079 | OR |
NPI | 1114974714 |
---|---|
Provider Name | Roseanne Marie Martin |
First Address | Gresham, OR 97030-7403 |
Second Address | Gresham, OR 97030-7403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
182905 | (05) | OR |