Healthcare Provider Details

I. General information

NPI: 1194239442
Provider Name (Legal Business Name): ABIGAIL JO BISSON ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2017
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 WALLACE RD NW
SALEM OR
97304-3007
US

IV. Provider business mailing address

28083 EWELTY WAY
CORVALLIS OR
97330
US

V. Phone/Fax

Practice location:
  • Phone: 503-371-1558
  • Fax:
Mailing address:
  • Phone: 541-666-8304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number4122
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4122
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: