Healthcare Provider Details

I. General information

NPI: 1164780458
Provider Name (Legal Business Name): NATHALIE PARAVICINI N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SW HAMPTON ST STE 130
TIGARD OR
97223-8374
US

IV. Provider business mailing address

5517 SE 65TH AVE
PORTLAND OR
97206-5424
US

V. Phone/Fax

Practice location:
  • Phone: 503-639-3777
  • Fax: 503-639-1120
Mailing address:
  • Phone: 971-244-4694
  • Fax: 971-244-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1890
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1890
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: