MEDICARE: GWYNNE ENGELKING N.D.

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
1	171100000X	Acupuncturist	AC176231	OR
2	175F00000X	Naturopath	3087	OR

General Provider Information

NPI Number	:	1831544485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWYNNE ENGELKING N.D.

Provider Business Mailing Address
First Line	:	7232 N BURLINGTON AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-4817
Country	:	US
Telephone Number	:	503-937-0060
Fax Number	:	844-778-7076

Provider Business Practice Location Address
First Line	:	7232 N BURLINGTON AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-4817
Country	:	US
Telephone Number	:	503-937-0060
Fax Number	:	844-778-7076

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	02/17/2017

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