Provider Demographics
NPI:1053730440
Name:GREEN LEAF NATURAL MEDICINE LLC
Entity type:Organization
Organization Name:GREEN LEAF NATURAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ND/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-888-5639
Mailing Address - Street 1:1020 SW TAYLOR ST STE 804
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2500
Mailing Address - Country:US
Mailing Address - Phone:971-888-5639
Mailing Address - Fax:888-972-4978
Practice Address - Street 1:1020 SW TAYLOR ST STE 804
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2500
Practice Address - Country:US
Practice Address - Phone:971-888-5639
Practice Address - Fax:888-972-4978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1967175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty