Healthcare Provider Details

I. General information

NPI: 1275177628
Provider Name (Legal Business Name): LAUREN SUTTON ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22400 SE STARK ST
GRESHAM OR
97030-2656
US

IV. Provider business mailing address

22400 SE STARK ST
GRESHAM OR
97030-2656
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number4279
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: