Provider Demographics
NPI:1487165502
Name:LOCKHART, DANA (ND, MSOM)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:ND, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 E BURNSIDE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1768
Mailing Address - Country:US
Mailing Address - Phone:503-281-6909
Mailing Address - Fax:
Practice Address - Street 1:20510 SW ROY ROGERS RD STE 100
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9320
Practice Address - Country:US
Practice Address - Phone:503-610-1531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4117175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath