Healthcare Provider Details

I. General information

NPI: 1659746097
Provider Name (Legal Business Name): DELIA SEWELL N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 SE STARK ST SUITE 102
GRESHAM OR
97030-3331
US

IV. Provider business mailing address

2822 SW 2ND AVE UPPER UNIT
PORTLAND OR
97201-4744
US

V. Phone/Fax

Practice location:
  • Phone: 503-492-1327
  • Fax:
Mailing address:
  • Phone: 404-348-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number3059
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: