Provider Demographics
NPI:1558907436
Name:NOURISHING MEDICINE
Entity Type:Organization
Organization Name:NOURISHING MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:503-860-8998
Mailing Address - Street 1:2403 SE MONROE ST STE A3
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7646
Mailing Address - Country:US
Mailing Address - Phone:503-860-8998
Mailing Address - Fax:503-236-8224
Practice Address - Street 1:2725 SE STEELE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-4617
Practice Address - Country:US
Practice Address - Phone:503-234-4858
Practice Address - Fax:503-236-8224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500662105Medicaid