Healthcare Provider Details

I. General information

NPI: 1700432879
Provider Name (Legal Business Name): MARLENA KURTZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NW 20TH ST STE 101
GRESHAM OR
97030-2442
US

IV. Provider business mailing address

500 NW 20TH ST STE 101
GRESHAM OR
97030-2442
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-2344
  • Fax:
Mailing address:
  • Phone: 503-489-5917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARLENA KENNEDY
Title or Position: OWNER
Credential: ND
Phone: 503-489-5917