Provider Demographics
NPI:1730583352
Name:PENDELL, HEATHER (ND)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:PENDELL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 N VILLA RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1855
Mailing Address - Country:US
Mailing Address - Phone:971-430-1156
Mailing Address - Fax:
Practice Address - Street 1:432 N VILLA RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1855
Practice Address - Country:US
Practice Address - Phone:971-430-1156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60986598OtherWASHINGTON STATE LICENSE
OR2069OtherOREGON LICENSE