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NPI Code Detail

MEDICARE: DR. REGINA IDA DEHEN ND, LAC

MEDICARE: DR. REGINA IDA DEHEN ND, LAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturistAC00285OR
2175F00000XNaturopathOR ND 0879OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023231222
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REGINA IDA DEHEN ND, LAC
Provider Business Mailing Address
First Line : 3025 SW CORBETT AVE
Second Line : NCNM CLINIC
City : PORTLAND
State : OR
Zip : 97201-4858
Country : US
Telephone Number : 503-552-1966
Fax Number : 503-226-8133
Provider Business Practice Location Address
First Line : 3025 SW CORBETT AVE
Second Line : NCNM CLINIC
City : PORTLAND
State : OR
Zip : 97201-4858
Country : US
Telephone Number : 503-552-1966
Fax Number : 503-226-8133
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 10/14/2013

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