Healthcare Provider Details

I. General information

NPI: 1932282100
Provider Name (Legal Business Name): NORTHWEST NATUROPATHIC MEDICAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 COBURG RD BLDG 6B
EUGENE OR
97401
US

IV. Provider business mailing address

1755 COBURG RD BLDG 6B
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-9357
  • Fax: 541-683-3273
Mailing address:
  • Phone: 541-683-9357
  • Fax: 541-683-3273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier150703
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: DR. STEPHANIE P WILSON
Title or Position: PRESIDENT
Credential: ND
Phone: 541-683-9357