Provider Demographics
NPI:1619343795
Name:DBA: ALICIA PETERMAN, ND
Entity Type:Organization
Organization Name:DBA: ALICIA PETERMAN, ND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PETERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-502-8398
Mailing Address - Street 1:2212 NE PRESCOTT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6406
Mailing Address - Country:US
Mailing Address - Phone:503-502-8398
Mailing Address - Fax:971-544-7482
Practice Address - Street 1:4203 SE HAWTHORNE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3160
Practice Address - Country:US
Practice Address - Phone:503-502-8398
Practice Address - Fax:971-544-7482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty