Individual
NATHAN IDROGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
7551 CRATER LAKE HWY STE B, WHITE CITY, OR 97503-1670
(541) 601-1708
Mailing address
7551 CRATER LAKE HWY STE B, WHITE CITY, OR 97503-1670
(541) 601-1708
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18349
OR
Other
Enumeration date
12/01/2023
Last updated
12/01/2023
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