Provider Demographics
NPI:1780129502
Name:KING, NOELLE DENISE (ND)
Entity type:Individual
Prefix:DR
First Name:NOELLE
Middle Name:DENISE
Last Name:KING
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 NE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211
Mailing Address - Country:US
Mailing Address - Phone:971-327-8338
Mailing Address - Fax:833-257-6059
Practice Address - Street 1:1616 SE ANKENY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1448
Practice Address - Country:US
Practice Address - Phone:971-327-8338
Practice Address - Fax:833-257-6059
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0122066175F00000X
OR4033175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500769313Medicaid
VT6707516Medicaid