Provider Demographics
NPI:1922731991
Name:NORTHWEST NATUROPATHIC ONCOLOGY LLC
Entity Type:Organization
Organization Name:NORTHWEST NATUROPATHIC ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIOT
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:607-343-6465
Mailing Address - Street 1:12354 SW WINTER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4739
Mailing Address - Country:US
Mailing Address - Phone:607-343-6465
Mailing Address - Fax:
Practice Address - Street 1:12354 SW WINTER LAKE DR
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4739
Practice Address - Country:US
Practice Address - Phone:607-343-6465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR4049OtherOREGON NATUROPATHIC PHYSICIAN LICENSE NUMBER