Provider Demographics
NPI:1821138512
Name:LEVINE, SAMANTHA (ND)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:LEVINE
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 1:6225 NE 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4227
Mailing Address - Country:US
Mailing Address - Phone:503-784-4073
Mailing Address - Fax:
Practice Address - Street 1:2256 N ALBINA AVE
Practice Address - Street 2:SUITE 179
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1774
Practice Address - Country:US
Practice Address - Phone:503-281-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1242175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath