Healthcare Provider Details

I. General information

NPI: 1679182992
Provider Name (Legal Business Name): ANDREW WOJCIECHOWSKI ND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 NW VAUGHN ST STE 424
PORTLAND OR
97210-5362
US

IV. Provider business mailing address

1116 SE LINCOLN ST
PORTLAND OR
97214-5353
US

V. Phone/Fax

Practice location:
  • Phone: 503-243-2699
  • Fax: 503-243-2698
Mailing address:
  • Phone: 586-381-6188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number4318
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: