Individual provider Active NPI

Emma Michelle Neiworth Petshow, ND

  • Naturopath
  • Vancouver, WA
National Provider Identifier
1053895615
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
NaturopathTaxonomy code 175F00000X
License
4171 Issued in OR
Practice address
13414 NE 23Rd Ave
Unit 427
Vancouver, WA 98686
Phone
(503) 664-1011
Fax
(866) 337-2677
NPI assigned
Sep 19, 2018
Last updated
Mar 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Naturopath 175F00000X 4171 OR Primary

Addresses

Primary practice location

13414 NE 23Rd Ave
Unit 427
Vancouver, WA 98686

Mailing address

13203 SE 172ND Ave Ste 166
Happy Valley, OR 97086-8738
Phone (503) 664-1011

Other practice location 1

3314 S Kelly Ave
Portland, OR 97239-4628
Phone (971) 284-0497

Other practice location 2

1725 Pearl St
Eugene, OR 97401-4118
Phone (971) 284-0497

Other identifiers 1

IdentifierTypeStateIssuer
500767312MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Empower U Health and Wellness LLC Naturopath CurrentSince Feb 21, 2022 Accepting new patients
Whitaker Wellness LLC PastSince Oct 1, 2021 Accepting new patients

Locations

1725 Pearl St
Eugene, OR 97401
Phone (541) 683-0886

13203 SE 172nd Ave
Ste 166
Happy Valley, OR 97086
Phone (415) 812-6637

3314 S Kelly Ave
Portland, OR 97239
Phone (503) 420-6467

Interoperability endpoints

  • Direct secure messaging: epetshow122061@direct.ochin.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1053895615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13203 SE 172ND AVE STE 166",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970868738",
            "telephone_number": "503-664-1011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13414 NE 23RD AVE",
            "address_2": "UNIT 427",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98686",
            "telephone_number": "503-664-1011",
            "fax_number": "866-337-2677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3314 S Kelly Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972394628",
            "country_code": "US",
            "telephone_number": "971-284-0497",
            "fax_number": "866-337-2677",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1725 Pearl St",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974014118",
            "country_code": "US",
            "telephone_number": "971-284-0497",
            "fax_number": "866-337-2677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NEIWORTH PETSHOW",
        "first_name": "EMMA",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "ND",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-19",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175F00000X",
            "taxonomy_group": "",
            "desc": "Naturopath",
            "state": "OR",
            "license": "4171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500767312",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.