Healthcare Provider Details

I. General information

NPI: 1730404914
Provider Name (Legal Business Name): ABRIANNE MARIE WILES GOSS N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 NW GREELEY AVE
BEND OR
97701-2914
US

IV. Provider business mailing address

106 NW GREELEY AVE
BEND OR
97701-2914
US

V. Phone/Fax

Practice location:
  • Phone: 541-585-3726
  • Fax: 541-585-3727
Mailing address:
  • Phone: 541-585-3726
  • Fax: 541-585-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1741
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: