Provider Demographics
NPI:1336446772
Name:MCCRARY, DEANNA (ND)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:
Last Name:MCCRARY
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 1:1340 SW BERTHA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2097
Mailing Address - Country:US
Mailing Address - Phone:503-946-6322
Mailing Address - Fax:503-766-3166
Practice Address - Street 1:1340 SW BERTHA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2097
Practice Address - Country:US
Practice Address - Phone:503-946-6322
Practice Address - Fax:503-766-3166
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1803175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500678774Medicaid