Provider Demographics
NPI:1053895615
Name:NEIWORTH PETSHOW, EMMA MICHELLE (ND)
Entity type:Individual
Prefix:DR
First Name:EMMA
Middle Name:MICHELLE
Last Name:NEIWORTH PETSHOW
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 1:13203 SE 172ND AVE STE 166
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-8738
Mailing Address - Country:US
Mailing Address - Phone:503-664-1011
Mailing Address - Fax:
Practice Address - Street 1:13414 NE 23RD AVE
Practice Address - Street 2:UNIT 427
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686
Practice Address - Country:US
Practice Address - Phone:503-664-1011
Practice Address - Fax:866-337-2677
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4171175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500767312Medicaid