Provider Demographics
NPI:1679729784
Name:WHITE, MISTY DAWN (ND)
Entity Type:Individual
Prefix:DR
First Name:MISTY
Middle Name:DAWN
Last Name:WHITE
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 1:14535 WESTLAKE DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7775
Mailing Address - Country:US
Mailing Address - Phone:503-746-5889
Mailing Address - Fax:503-208-8025
Practice Address - Street 1:14535 WESTLAKE DR STE B
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7775
Practice Address - Country:US
Practice Address - Phone:503-746-5889
Practice Address - Fax:503-208-8025
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-09
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1605175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath