Provider Demographics
NPI:1164799813
Name:BERZOW, REBECCA (N D)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BERZOW
Suffix:
Gender:F
Credentials:N D
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:MACDOUGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:15455 NW GREENBRIER PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7374
Mailing Address - Country:US
Mailing Address - Phone:971-231-4372
Mailing Address - Fax:971-277-6027
Practice Address - Street 1:15455 NW GREENBRIER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7374
Practice Address - Country:US
Practice Address - Phone:971-231-4372
Practice Address - Fax:971-277-6027
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1871175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500652171Medicaid
OR1730518754OtherGROUP NPI