Provider Demographics
NPI:1972078798
Name:BRANSTETTER, SULIE HANNAH (ND)
Entity Type:Individual
Prefix:
First Name:SULIE
Middle Name:HANNAH
Last Name:BRANSTETTER
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 1:16620 TUDOR DR
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-1034
Mailing Address - Country:US
Mailing Address - Phone:907-209-4533
Mailing Address - Fax:
Practice Address - Street 1:818 SW FOREST AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2737
Practice Address - Country:US
Practice Address - Phone:541-214-2018
Practice Address - Fax:833-643-0179
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4154175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath