Provider Demographics
NPI:1669811204
Name:POTTER, CAMELLA M (ND)
Entity type:Individual
Prefix:
First Name:CAMELLA
Middle Name:M
Last Name:POTTER
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 1:605 UNION ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2462
Mailing Address - Country:US
Mailing Address - Phone:503-804-4730
Mailing Address - Fax:888-959-9018
Practice Address - Street 1:605 UNION ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2462
Practice Address - Country:US
Practice Address - Phone:971-207-3680
Practice Address - Fax:503-339-9585
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1959175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500672146Medicaid
OR500665861Medicaid
1396159109OtherNPI2