Provider Demographics
NPI:1912558818
Name:BENKLEY, MARIE JACQUELIN (ND)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:JACQUELIN
Last Name:BENKLEY
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 1:6105 NE 13TH AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4234
Mailing Address - Country:US
Mailing Address - Phone:617-610-0305
Mailing Address - Fax:
Practice Address - Street 1:049 SW PORTER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4848
Practice Address - Country:US
Practice Address - Phone:503-552-1562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath