Provider Demographics
NPI:1316217342
Name:DEWITT, KAREN (ND)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:DEWITT
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 1:10360 NE WASCO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3927
Mailing Address - Country:US
Mailing Address - Phone:971-212-2553
Mailing Address - Fax:503-256-8422
Practice Address - Street 1:10360 NE WASCO ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3927
Practice Address - Country:US
Practice Address - Phone:971-212-2553
Practice Address - Fax:503-256-8422
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1873175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
45-4167048OtherEIN