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NPI Code Detail

MEDICARE: PORTLAND WELLNESS PROJECT LLC

MEDICARE: PORTLAND WELLNESS PROJECT LLC
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
1175F00000XNaturopath

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11225218977OTHERORNPPES
21073941399OTHERORNPPES

General Provider Information

NPI Number : 1366167629
Entity Type Code : Organization
Provider Name (Legal Business Name) : PORTLAND WELLNESS PROJECT LLC
Provider Business Mailing Address
First Line : 3954 NE CLEVELAND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97212-1005
Country : US
Telephone Number : 503-880-8452
Fax Number :
Provider Business Practice Location Address
First Line : 1901 N KILLINGSWORTH ST
Second Line :
City : PORTLAND
State : OR
Zip : 97217-4436
Country : US
Telephone Number : 503-880-8452
Fax Number :
Authorized Official
Title or Position : OWNER, PHYSICIAN
Name : DR. ILANA GUREVICH
Credential : ND, LAC
Telephone Number : 503-880-8452
Provider Enumeration Date : 10/10/2022
Last Update Date : 04/16/2026

Similar Medicare Providers

1225218977 — DR. ILANA GUREVICH ND, LAC
Practice Location Address:
1901 N KILLINGSWORTH ST
PORTLAND, OR
97217-4436
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Practice Fax: 833-450-6082
1396083242 — ERICA LYNN SIMONICH WHNP
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1033932249 — DR. KELLY CAROLYN PRICE ND, LAC
Practice Location Address:
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Practice Fax:
1639964828 — PORTLAND WELLNESS PROJECT LLC
Practice Location Address:
1901 N KILLINGSWORTH ST
PORTLAND, OR
97217-4436
Practice Phone: 503-770-0670
Practice Fax: 833-450-6082
1326912684 — HANNA ROSENTHAL
Practice Location Address:
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PORTLAND, OR
97217-4436
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Practice Fax:
1588673040 — MR. PAUL P OUELLETTE LCSW
Practice Location Address:
83 NOYES ST
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04103-4436
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Directions to “PORTLAND WELLNESS PROJECT LLC ” Practice Location

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