Provider Demographics
NPI:1578597829
Name:GRABOWSKA, MARY J (ND, LM, LAC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:J
Last Name:GRABOWSKA
Suffix:
Gender:F
Credentials:ND, LM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 NE BROADWAY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1791
Mailing Address - Country:US
Mailing Address - Phone:503-236-6006
Mailing Address - Fax:503-232-3436
Practice Address - Street 1:2207 NE BROADWAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1791
Practice Address - Country:US
Practice Address - Phone:503-236-6006
Practice Address - Fax:503-232-3436
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00272171100000X
OR794175F00000X
WAMW00000176176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7102759Medicaid
OR119870Medicaid