Provider Demographics
NPI:1093346595
Name:DOCTRINE, CORINA (ND)
Entity Type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:DOCTRINE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SW 141ST AVE APT 42
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3769
Mailing Address - Country:US
Mailing Address - Phone:503-927-9906
Mailing Address - Fax:
Practice Address - Street 1:9430 SW CORAL ST STE 203
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-6692
Practice Address - Country:US
Practice Address - Phone:503-644-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4253175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath