Individual
TRACY BOSNIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NTP
Contact information
Practice address
2123 SE 37TH AVE, PORTLAND, OR 97214-5817
(503) 236-2220
Mailing address
2123 SE 37TH AVE, PORTLAND, OR 97214-5817
(503) 236-2220
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
000333
WA
Other
Enumeration date
03/16/2011
Last updated
03/16/2011
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