Healthcare Provider Details

I. General information

NPI: 1578597829
Provider Name (Legal Business Name): MARY J GRABOWSKA ND, LM, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 NE BROADWAY ST SUITE 200
PORTLAND OR
97232-1791
US

IV. Provider business mailing address

2207 NE BROADWAY ST SUITE 200
PORTLAND OR
97232-1791
US

V. Phone/Fax

Practice location:
  • Phone: 503-236-6006
  • Fax: 503-232-3436
Mailing address:
  • Phone: 503-236-6006
  • Fax: 503-232-3436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00272
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number794
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW00000176
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: