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General NPI Number Information
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NPI Number | 1366167629
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Entity Type | Organization
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Legal Business Name | PORTLAND WELLNESS PROJECT
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 1901 N KILLINGSWORTH ST
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City | PORTLAND
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State | OR
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Zip | 97217-4436
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Country | US
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Telephone | 503-880-8452
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Fax |
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Provider Business Mailing Address
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Address Line | 3954 NE CLEVELAND AVE
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City | PORTLAND
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State | OR
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Zip | 97212-1005
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Country | US
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Telephone | 503-880-8452
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICIAN
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Name | DR. ILANA GUREVICH
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Credential | ND, LAC
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Telephone | 503-880-8452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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