Provider Demographics
NPI:1780189332
Name:STEVENS, SAMARA LOREN (ND)
Entity Type:Individual
Prefix:DR
First Name:SAMARA
Middle Name:LOREN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:SAMARA
Other - Middle Name:LOREN
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3530 N VANCOUVER AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1798
Mailing Address - Country:US
Mailing Address - Phone:503-249-8851
Mailing Address - Fax:503-282-3409
Practice Address - Street 1:6110 N LOMBARD ST STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4122
Practice Address - Country:US
Practice Address - Phone:503-897-9711
Practice Address - Fax:503-854-0194
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4174175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500753516Medicaid