Provider Demographics
NPI:1588336416
Name:MCDOUGAL, NATASHA ELIZABETH (ND)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:ELIZABETH
Last Name:MCDOUGAL
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 1:14948 NE ROSE PKWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-4521
Mailing Address - Country:US
Mailing Address - Phone:971-285-0120
Mailing Address - Fax:
Practice Address - Street 1:7477 SE 52ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-8206
Practice Address - Country:US
Practice Address - Phone:503-388-6408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4418175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath