Provider Demographics
NPI:1700038403
Name:PREMAZZI, ANDREA LEA (ND)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LEA
Last Name:PREMAZZI
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:PO BOX 2669
Mailing Address - Street 2:
Mailing Address - City:ESTACADA
Mailing Address - State:OR
Mailing Address - Zip Code:97023-2669
Mailing Address - Country:US
Mailing Address - Phone:503-630-6288
Mailing Address - Fax:503-630-2245
Practice Address - Street 1:121N BROADWAY ST
Practice Address - Street 2:NW CENTER FOR NATURAL MEDICINE
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023
Practice Address - Country:US
Practice Address - Phone:503-630-6288
Practice Address - Fax:503-630-2245
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1636175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath