Provider Demographics
NPI:1144318676
Name:SQUELLATI, ANA M (ND)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:M
Last Name:SQUELLATI
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:123 E POWELL BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7622
Mailing Address - Country:US
Mailing Address - Phone:503-341-4132
Mailing Address - Fax:503-665-2337
Practice Address - Street 1:123 E POWELL BLVD STE 207
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7622
Practice Address - Country:US
Practice Address - Phone:503-341-4132
Practice Address - Fax:503-665-2337
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1041175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1041OtherSTATE LICENSE