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NPI Code Detail

MEDICARE: DR. AUDRA GESIK ND

MEDICARE: DR. AUDRA GESIK ND
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175F00000XNaturopath4368OR

General Provider Information

NPI Number : 1558966218
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AUDRA GESIK ND
Provider Business Mailing Address
First Line : 113 N ELM ST
Second Line :
City : CANBY
State : OR
Zip : 97013-3519
Country : US
Telephone Number : 503-263-8903
Fax Number :
Provider Business Practice Location Address
First Line : 5291 NE ELAM YOUNG PKWY STE 160
Second Line :
City : HILLSBORO
State : OR
Zip : 97124-7560
Country : US
Telephone Number : 503-372-5147
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2020
Last Update Date : 12/01/2020

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