Provider Demographics
NPI:1700114345
Name:JEANNE, PAMELA SKY (ND)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SKY
Last Name:JEANNE
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 1:2137 N SARATOGA ST
Mailing Address - Street 2:PORTLAND
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5360
Mailing Address - Country:US
Mailing Address - Phone:503-720-8999
Mailing Address - Fax:503-200-1334
Practice Address - Street 1:2137 N SARATOGA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5360
Practice Address - Country:US
Practice Address - Phone:503-720-8999
Practice Address - Fax:503-200-1334
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0745175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath