Healthcare Provider Details

I. General information

NPI: 1225412620
Provider Name (Legal Business Name): NATIONAL UNIVERSITY OF NATURAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 SW CORBETT AVE
PORTLAND OR
97201-4858
US

IV. Provider business mailing address

049 SW PORTER ST
PORTLAND OR
97201-4848
US

V. Phone/Fax

Practice location:
  • Phone: 503-552-1551
  • Fax:
Mailing address:
  • Phone: 503-552-1551
  • Fax: 503-226-8133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number0879
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number0879
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberND0879
License Number StateOR

VIII. Authorized Official

Name: DR. REGINA IDA DEHEN
Title or Position: CMO AND DEAN OF CLINICS
Credential: ND LAC
Phone: 503-552-1966