Provider Demographics
NPI:1164780458
Name:PARAVICINI, NATHALIE (ND)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:
Last Name:PARAVICINI
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 1:5517 SE 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5424
Mailing Address - Country:US
Mailing Address - Phone:971-244-4694
Mailing Address - Fax:971-244-9494
Practice Address - Street 1:7000 SW HAMPTON ST STE 130
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8374
Practice Address - Country:US
Practice Address - Phone:503-639-3777
Practice Address - Fax:503-639-1120
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1890175F00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMP2699417OtherDEA