Provider Demographics
NPI:1760529564
Name:LOOMIS, MARNIE (ND)
Entity Type:Individual
Prefix:DR
First Name:MARNIE
Middle Name:
Last Name:LOOMIS
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 1:5225 JEAN RD APT 604
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7140
Mailing Address - Country:US
Mailing Address - Phone:503-544-7044
Mailing Address - Fax:503-445-9772
Practice Address - Street 1:111 SW COLUMBIA ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5848
Practice Address - Country:US
Practice Address - Phone:503-222-0551
Practice Address - Fax:503-224-9619
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1100175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
12646084OtherCAQH