Provider Demographics
NPI:1316155245
Name:LACROUTE, NATHALIE SABINE (ND)
Entity type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:SABINE
Last Name:LACROUTE
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 1:7445 SE 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-8546
Mailing Address - Country:US
Mailing Address - Phone:503-888-9396
Mailing Address - Fax:503-772-3536
Practice Address - Street 1:8113 SE 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6607
Practice Address - Country:US
Practice Address - Phone:503-888-9396
Practice Address - Fax:503-772-3536
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1334175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath