Provider Demographics
NPI:1366599961
Name:CARUSO, PETRA ANNE (ND)
Entity type:Individual
Prefix:DR
First Name:PETRA
Middle Name:ANNE
Last Name:CARUSO
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 1:7219 SE YAMHILL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215
Mailing Address - Country:US
Mailing Address - Phone:503-415-1158
Mailing Address - Fax:503-334-0891
Practice Address - Street 1:7219 SE YAMHILL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215
Practice Address - Country:US
Practice Address - Phone:503-415-1158
Practice Address - Fax:503-334-0891
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1521175F00000X
OROR1521175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath