Provider Demographics
NPI:1962778605
Name:SIMONIS, EMILY JANE (ND)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:JANE
Last Name:SIMONIS
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 1:7878 SW PETERS RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7619
Mailing Address - Country:US
Mailing Address - Phone:541-913-7573
Mailing Address - Fax:
Practice Address - Street 1:7878 SW PETERS RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7619
Practice Address - Country:US
Practice Address - Phone:541-913-7573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1872175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath