Provider Demographics
NPI:1720707144
Name:DODD INTEGRATIVE MEDICINE
Entity type:Organization
Organization Name:DODD INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAMARA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DODD
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:541-404-4485
Mailing Address - Street 1:644 RAY LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2466
Mailing Address - Country:US
Mailing Address - Phone:541-404-4485
Mailing Address - Fax:541-225-4884
Practice Address - Street 1:644 RAY LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2466
Practice Address - Country:US
Practice Address - Phone:541-404-4485
Practice Address - Fax:541-225-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty