Provider Demographics
NPI:1306963806
Name:KRISKO, REBECCA ELIZABETH (ND)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:KRISKO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:ASMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:2240 N INTERSTATE AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1771
Mailing Address - Country:US
Mailing Address - Phone:503-274-9360
Mailing Address - Fax:503-274-9370
Practice Address - Street 1:2256 N ALBINA AVE STE 160
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1774
Practice Address - Country:US
Practice Address - Phone:503-274-9360
Practice Address - Fax:503-274-9370
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1318175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath