Healthcare Provider Details

I. General information

NPI: 1417277104
Provider Name (Legal Business Name): MARLANE BASSETT ND INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3769 SE MILWAUKIE AVE
PORTLAND OR
97202-3804
US

IV. Provider business mailing address

PO BOX 11864
PORTLAND OR
97211-0864
US

V. Phone/Fax

Practice location:
  • Phone: 503-235-2120
  • Fax: 503-345-0964
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number847
License Number StateOR

VIII. Authorized Official

Name: MARLANE BASSETT
Title or Position: PRESIDENT
Credential: ND
Phone: 503-235-2120