MEDICARE: DR. KRISTA LYNN TRICARICO N.D.

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
1	175F00000X	Naturopath	1493	OR

General Provider Information

NPI Number	:	1619015369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTA LYNN TRICARICO N.D.

Provider Business Mailing Address
First Line	:	1743 NE JUNIOR ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-4859
Country	:	US
Telephone Number	:	503-593-8900
Fax Number	:	503-234-2805

Provider Business Practice Location Address
First Line	:	1016 SE 12TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-2513
Country	:	US
Telephone Number	:	503-593-8900
Fax Number	:	503-234-2805

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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