Provider Demographics
NPI:1679825962
Name:MAY, JOANNA KOERPER (ND)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:KOERPER
Last Name:MAY
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 1:1626 NE 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6740
Mailing Address - Country:US
Mailing Address - Phone:503-894-6634
Mailing Address - Fax:
Practice Address - Street 1:2100 NE BROADWAY ST STE 225
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1544
Practice Address - Country:US
Practice Address - Phone:503-719-5000
Practice Address - Fax:971-255-1754
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1922175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500675634Medicaid