Provider Demographics
NPI:1639458011
Name:HEALING RESOURCES NW, LLC
Entity Type:Organization
Organization Name:HEALING RESOURCES NW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NAMETKA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CWS, CWON, FNP-
Authorized Official - Phone:971-895-0060
Mailing Address - Street 1:7914 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3031
Mailing Address - Country:US
Mailing Address - Phone:503-888-0390
Mailing Address - Fax:888-898-0933
Practice Address - Street 1:7914 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3031
Practice Address - Country:US
Practice Address - Phone:503-888-0390
Practice Address - Fax:888-898-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty