Provider Demographics
NPI:1467856955
Name:BENNETT, MEGHAN ELLEN REVOIR (ND)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:ELLEN REVOIR
Last Name:BENNETT
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 1:3340 SE MORRISON ST
Mailing Address - Street 2:APT. 328
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3191
Mailing Address - Country:US
Mailing Address - Phone:503-863-4451
Mailing Address - Fax:503-419-6202
Practice Address - Street 1:330 SE 3RD STREET
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060
Practice Address - Country:US
Practice Address - Phone:503-863-4451
Practice Address - Fax:503-419-6202
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2062175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath