MEDICARE: NORTHWEST NATUROPATHIC ONCOLOGY 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
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4049	OTHER	OR	OREGON NATUROPATHIC PHYSICIAN LICENSE NUMBER

General Provider Information

NPI Number	:	1922731991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST NATUROPATHIC ONCOLOGY LLC

Provider Business Mailing Address
First Line	:	12354 SW WINTER LAKE DR
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-4739
Country	:	US
Telephone Number	:	607-343-6465
Fax Number	:

Provider Business Practice Location Address
First Line	:	12354 SW WINTER LAKE DR
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-4739
Country	:	US
Telephone Number	:	607-343-6465
Fax Number	:

Authorized Official
Title or Position	:	NATUROPATHIC PHYSICIAN/OWNER
Name	:	DR. ELIOT WESLEY EDWARDS
Credential	:	ND
Telephone Number	:	607-343-6465

Provider Enumeration Date	:	07/06/2022
Last Update Date	:	07/06/2022

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