Provider Demographics
NPI:1831544485
Name:ENGELKING, GWYNNE (ND)
Entity type:Individual
Prefix:
First Name:GWYNNE
Middle Name:
Last Name:ENGELKING
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 1:7232 N BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4817
Mailing Address - Country:US
Mailing Address - Phone:503-937-0060
Mailing Address - Fax:844-778-7076
Practice Address - Street 1:7232 N BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4817
Practice Address - Country:US
Practice Address - Phone:503-937-0060
Practice Address - Fax:844-778-7076
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC176231171100000X
OR3087175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist