Provider Demographics
NPI:1063849073
Name:WILLIAMS DEL-OLMO, ANDREA TRELEASE (ND)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:TRELEASE
Last Name:WILLIAMS DEL-OLMO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 SE 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1801
Mailing Address - Country:US
Mailing Address - Phone:503-504-8848
Mailing Address - Fax:
Practice Address - Street 1:819 SE MORRISON ST STE 115
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-6307
Practice Address - Country:US
Practice Address - Phone:503-956-9396
Practice Address - Fax:866-883-0582
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1979175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath