Provider Demographics
NPI:1043388119
Name:FLEWELLING, KATHLEEN RENEE (ND)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:RENEE
Last Name:FLEWELLING
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 1:720 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-6802
Mailing Address - Country:US
Mailing Address - Phone:503-738-5859
Mailing Address - Fax:503-738-7726
Practice Address - Street 1:720 1ST AVE
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-6802
Practice Address - Country:US
Practice Address - Phone:503-738-5859
Practice Address - Fax:503-738-7726
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR931175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath