Provider Demographics
NPI:1538567169
Name:RENEW HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:RENEW HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, NATUROPATHIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-208-4557
Mailing Address - Street 1:5440 SW WESTGATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2420
Mailing Address - Country:US
Mailing Address - Phone:503-208-4557
Mailing Address - Fax:503-296-8414
Practice Address - Street 1:5440 SW WESTGATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2420
Practice Address - Country:US
Practice Address - Phone:503-208-4557
Practice Address - Fax:503-296-8414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-14
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2038261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care