Healthcare Provider Details

I. General information

NPI: 1619343795
Provider Name (Legal Business Name): DBA: ALICIA PETERMAN, ND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 SE HAWTHORNE BLVD SUITE A
PORTLAND OR
97215-3160
US

IV. Provider business mailing address

2212 NE PRESCOTT ST
PORTLAND OR
97211-6406
US

V. Phone/Fax

Practice location:
  • Phone: 503-502-8398
  • Fax: 971-544-7482
Mailing address:
  • Phone: 503-502-8398
  • Fax: 971-544-7482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. ALICIA RENEE PETERMAN
Title or Position: NATUROPATHIC PHYSICIAN
Credential: ND
Phone: 503-502-8398