Provider Demographics
NPI:1417327933
Name:PETHERBRIDGE, CAROL J (ND)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:J
Last Name:PETHERBRIDGE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:155 SW CENTURY DR SUITE 111
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702
Mailing Address - Country:US
Mailing Address - Phone:541-797-6224
Mailing Address - Fax:541-797-6274
Practice Address - Street 1:198 SOUTH EAST 3RD STREET
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-241-2763
Practice Address - Fax:541-897-8960
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-26
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0667R175F00000X
OR0667-R175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath