Provider Demographics
NPI:1588613814
Name:ABRAHAM, WENDY RENEE (ND)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:RENEE
Last Name:ABRAHAM
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 1:16771 SW 12TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-6023
Mailing Address - Country:US
Mailing Address - Phone:503-610-1194
Mailing Address - Fax:503-217-9989
Practice Address - Street 1:16771 SW 12TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-6023
Practice Address - Country:US
Practice Address - Phone:503-610-1194
Practice Address - Fax:503-217-9989
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1303175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath