Provider Demographics
NPI:1982685806
Name:COLLINS, ELIZABETH W (ND, LM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:W
Last Name:COLLINS
Suffix:
Gender:F
Credentials:ND, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5834 SE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5226
Mailing Address - Country:US
Mailing Address - Phone:503-232-1925
Mailing Address - Fax:
Practice Address - Street 1:10360 NE WASCO ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3927
Practice Address - Country:US
Practice Address - Phone:503-252-8125
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR869175F00000X
WAMW00000227176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered175F00000XOther Service ProvidersNaturopath
Not Answered176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR138235Medicaid
WA7102742Medicaid
ORMC0630295OtherDEA REGISTRATION NUMBER