Provider Demographics
NPI:1447079298
Name:PNW NATURAL MEDICINE
Entity type:Organization
Organization Name:PNW NATURAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:NGUYEN-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:971-361-6155
Mailing Address - Street 1:15548 SW WINTERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2616
Mailing Address - Country:US
Mailing Address - Phone:971-246-1382
Mailing Address - Fax:503-213-6330
Practice Address - Street 1:10110 SW NIMBUS AVE STE B3
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4359
Practice Address - Country:US
Practice Address - Phone:971-213-5775
Practice Address - Fax:503-213-6330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR ALEXANDRIA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-08
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500753165Medicaid
OR500753160Medicaid