Healthcare Provider Details

I. General information

NPI: 1194175638
Provider Name (Legal Business Name): KATHERINE ZIEMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22400 SE STARK ST SUITE 105
GRESHAM OR
97030-2656
US

IV. Provider business mailing address

22400 SE STARK ST SUITE 105
GRESHAM OR
97030-2656
US

V. Phone/Fax

Practice location:
  • Phone: 503-492-1221
  • Fax: 503-907-0098
Mailing address:
  • Phone: 503-492-1221
  • Fax: 503-907-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0799
License Number StateOR

VIII. Authorized Official

Name: KATHERINE ANN ZIEMAN
Title or Position: OWNER
Credential: N.D.
Phone: 503-784-6203