Provider Demographics
NPI:1972893055
Name:EDWARDS, JEFF T (ND)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:T
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12616 SE STARK ST BLDG. L PLAZA 125
Mailing Address - Street 2:NAMASTE NATURAL HEALING CENTER INC.
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233
Mailing Address - Country:US
Mailing Address - Phone:503-408-0790
Mailing Address - Fax:503-408-0791
Practice Address - Street 1:12616 SE STARK ST
Practice Address - Street 2:NAMASTE NATURAL HEALING CENTER INC.
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233
Practice Address - Country:US
Practice Address - Phone:503-408-0790
Practice Address - Fax:503-408-0791
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR#1733175F00000X
WANT60168200175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath