Provider Demographics
NPI:1538794391
Name:AWAKEN NATURAL MEDICINE INC
Entity type:Organization
Organization Name:AWAKEN NATURAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:ND RPH
Authorized Official - Phone:503-422-6913
Mailing Address - Street 1:505 NW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3578
Mailing Address - Country:US
Mailing Address - Phone:503-422-6913
Mailing Address - Fax:888-511-7659
Practice Address - Street 1:505 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3578
Practice Address - Country:US
Practice Address - Phone:503-422-6913
Practice Address - Fax:888-511-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500721816Medicaid