Healthcare Provider Details

I. General information

NPI: 1053895615
Provider Name (Legal Business Name): EMMA MICHELLE NEIWORTH PETSHOW ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 03/12/2024
Certification Date: 03/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13414 NE 23RD AVE UNIT 427
VANCOUVER WA
98686
US

IV. Provider business mailing address

13203 SE 172ND AVE STE 166
HAPPY VALLEY OR
97086-8738
US

V. Phone/Fax

Practice location:
  • Phone: 503-664-1011
  • Fax: 866-337-2677
Mailing address:
  • Phone: 503-664-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number4171
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: