Provider Demographics
NPI:1932117306
Name:PETERSON, NOEL S (ND)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:S
Last Name:PETERSON
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 FIRST STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3272
Mailing Address - Country:US
Mailing Address - Phone:503-636-2734
Mailing Address - Fax:503-636-3250
Practice Address - Street 1:560 FIRST STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3272
Practice Address - Country:US
Practice Address - Phone:503-636-2734
Practice Address - Fax:503-636-3250
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR440175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath