Healthcare Provider Details

I. General information

NPI: 1184266132
Provider Name (Legal Business Name): DANA NELL MOCKENHAUPT ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4246 SE BELMONT ST STE 5
PORTLAND OR
97215-1676
US

IV. Provider business mailing address

19854 25TH AVE NE APT B
SHORELINE WA
98155-1350
US

V. Phone/Fax

Practice location:
  • Phone: 503-445-8114
  • Fax:
Mailing address:
  • Phone: 208-861-3758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number4269
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: