Healthcare Provider Details

I. General information

NPI: 1063685543
Provider Name (Legal Business Name): NORTHWEST NATURAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 SE WASHINGTON ST SUITE 104
MILWAUKIE OR
97222-7647
US

IV. Provider business mailing address

2305 SE WASHINGTON STREET. SUITE 104
MILWAUKIE OR
97222-7467
US

V. Phone/Fax

Practice location:
  • Phone: 503-786-2181
  • Fax: 503-200-2259
Mailing address:
  • Phone: 503-786-2181
  • Fax: 503-200-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1592
License Number StateOR

VIII. Authorized Official

Name: DR. JESSE IAN BUTTLER
Title or Position: OWNER
Credential: N.D.
Phone: 503-786-2181