Healthcare Provider Details

I. General information

NPI: 1114330925
Provider Name (Legal Business Name): OLIF WOJCIECHOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 NW 14TH AVE APT 310
PORTLAND OR
97209-2545
US

IV. Provider business mailing address

1550 NW 14TH AVE APT 310
PORTLAND OR
97209-2545
US

V. Phone/Fax

Practice location:
  • Phone: 503-839-8302
  • Fax:
Mailing address:
  • Phone: 503-839-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT 60472418
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: