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General NPI Number Information
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NPI Number | 1447692579
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Entity Type | Organization
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Legal Business Name | EARTH FRIENDLY MEDICINE, LLC
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 08/31/2015
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Provider Practice Location Address
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Address Line | 4031 SE HAWTHORNE BLVD
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City | PORTLAND
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State | OR
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Zip | 97214-5243
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Country | US
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Telephone | 503-546-7663
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Fax | 503-231-6605
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Provider Business Mailing Address
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Address Line | 4031 SE HAWTHORNE BLVD
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City | PORTLAND
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State | OR
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Zip | 97214-5243
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Country | US
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Telephone | 503-546-7663
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Fax | 503-231-6605
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MICHELLE WINCHELL
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Credential | N.D., L.AC.
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Telephone | 503-546-7663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | AC161444
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 1941
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License Number State | OR
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