Healthcare Provider Details

I. General information

NPI: 1366504219
Provider Name (Legal Business Name): GEORGIA E KYBA ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 SE HARRISON ST SUITE B
MILWAUKIE OR
97222-5899
US

IV. Provider business mailing address

6335 NE 7TH AVE
PORTLAND OR
97211-3601
US

V. Phone/Fax

Practice location:
  • Phone: 503-830-0946
  • Fax:
Mailing address:
  • Phone: 503-830-0946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1447
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: