Healthcare Provider Details

I. General information

NPI: 1144318676
Provider Name (Legal Business Name): ANA M SQUELLATI ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E POWELL BLVD STE 207
GRESHAM OR
97030-7622
US

IV. Provider business mailing address

123 E POWELL BLVD STE 207
GRESHAM OR
97030-7622
US

V. Phone/Fax

Practice location:
  • Phone: 503-341-4132
  • Fax: 503-665-2337
Mailing address:
  • Phone: 503-341-4132
  • Fax: 503-665-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1041
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: