Provider Demographics
NPI:1760640049
Name:SOLLUNA MEDICINE
Entity Type:Organization
Organization Name:SOLLUNA MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-730-6725
Mailing Address - Street 1:7357 SW BEVELAND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8844
Mailing Address - Country:US
Mailing Address - Phone:503-670-4941
Mailing Address - Fax:
Practice Address - Street 1:7357 SW BEVELAND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8844
Practice Address - Country:US
Practice Address - Phone:503-670-4941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1427175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty