Provider Demographics
NPI:1467969220
Name:NW MIND-BODY WELLNESS, LLC
Entity Type:Organization
Organization Name:NW MIND-BODY WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:503-707-1950
Mailing Address - Street 1:4804 NW BETHANY BLVD
Mailing Address - Street 2:STE I2 #280
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229
Mailing Address - Country:US
Mailing Address - Phone:503-707-1950
Mailing Address - Fax:503-296-2700
Practice Address - Street 1:16986 NW LYNCH LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-1221
Practice Address - Country:US
Practice Address - Phone:615-497-1146
Practice Address - Fax:615-497-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201406327NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty