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1275088015 NPI number — STERLING SYNNOVE DORMAN CRITTENDEN ND

NPI Number: 1275088015
Health Care Provider/Practitioner: STERLING SYNNOVE DORMAN CRITTENDEN ND

Information about “1275088015” NPI (STERLING SYNNOVE DORMAN CRITTENDEN ND) exists in 1275088015 in HTML format HTML  |  1275088015 in plain Text format TXT  |  1275088015 in PDF (Portable Document Format) PDF  |  1275088015 in an XML format XML  formats.

NPI Number : 1275088015 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275088015",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CRITTENDEN",
    "FirstName": "STERLING",
    "MiddleName": "SYNNOVE DORMAN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "ND",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "515 NW SALTZMAN RD # 769",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORTLAND",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97229-6098",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-724-6730",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4605 NE FREMONT ST STE 204A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORTLAND",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97213-1715",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-724-6730",
    "PracticeLocationAddressFaxNumber": "503-766-5979",
    "EnumerationDate": "08/22/2016",
    "LastUpdateDate": "07/06/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "175F00000X",
          "TaxonomyName": "Naturopath",
          "LicenseNumber": "ND-341-0",
          "LicenseNumberStateCode": "HI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "175F00000X",
          "TaxonomyName": "Naturopath",
          "LicenseNumber": "4003",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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