Provider Demographics
NPI:1053908988
Name:MAGNOLIA FAMILY CLINIC
Entity type:Organization
Organization Name:MAGNOLIA FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRABOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC, LM
Authorized Official - Phone:503-236-6006
Mailing Address - Street 1:2207 NE BROADWAY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1791
Mailing Address - Country:US
Mailing Address - Phone:503-701-3375
Mailing Address - Fax:503-232-3436
Practice Address - Street 1:2207 NE BROADWAY ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1791
Practice Address - Country:US
Practice Address - Phone:503-701-3375
Practice Address - Fax:503-232-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty