Provider Demographics
NPI:1003931361
Name:RAPPORT, PHYLLIS GEGA (ND)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:GEGA
Last Name:RAPPORT
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:
Other - Last Name:GEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7929 SW 37TH AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3663
Mailing Address - Country:US
Mailing Address - Phone:503-977-3323
Mailing Address - Fax:503-239-6114
Practice Address - Street 1:7929 SW 37TH AVE
Practice Address - Street 2:SUITE E
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219
Practice Address - Country:US
Practice Address - Phone:503-977-3323
Practice Address - Fax:503-239-6114
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR822175F00000X
OR58176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered175F00000XOther Service ProvidersNaturopath
Not Answered176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR071063Medicaid