Individual
LIBERTY BLANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.D.
Contact information
Practice address
164 NW MACLEAY BLVD, PORTLAND, OR 97210
(603) 228-1253
Mailing address
164 NW MACLEAY BLVD, PORTLAND, OR 97210
(603) 228-1253
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
4177
OR
Other
Enumeration date
10/31/2018
Last updated
10/31/2018
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