Healthcare Provider Details

I. General information

NPI: 1396754263
Provider Name (Legal Business Name): PAMELA A PAVILONIS N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21860 WILLAMETTE DR
WEST LINN OR
97068-3256
US

IV. Provider business mailing address

13825 SE BEECH ST
MILWAUKIE OR
97222
US

V. Phone/Fax

Practice location:
  • Phone: 503-650-2394
  • Fax: 503-905-6180
Mailing address:
  • Phone: 503-659-2249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1129
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: