Provider Demographics
NPI:1932282100
Name:NORTHWEST NATUROPATHIC MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:NORTHWEST NATUROPATHIC MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:541-683-9357
Mailing Address - Street 1:1755 COBURG RD
Mailing Address - Street 2:BLDG 6B
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-683-9357
Mailing Address - Fax:541-683-3273
Practice Address - Street 1:1755 COBURG RD
Practice Address - Street 2:BLDG 6B
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-683-9357
Practice Address - Fax:541-683-3273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150703Medicaid