Provider Demographics
NPI:1548954712
Name:MADER, PAULA ALICE (ND, MSAOM)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:ALICE
Last Name:MADER
Suffix:
Gender:F
Credentials:ND, MSAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6564 SE LAKE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2238
Mailing Address - Country:US
Mailing Address - Phone:503-747-2021
Mailing Address - Fax:503-747-2802
Practice Address - Street 1:6564 SE LAKE RD STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222-2238
Practice Address - Country:US
Practice Address - Phone:503-747-2021
Practice Address - Fax:503-747-2802
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5008175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath