Healthcare Provider Details

I. General information

NPI: 1457298234
Provider Name (Legal Business Name): MARTA NELSON LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14455 SW ALLEN BLVD STE 101
BEAVERTON OR
97005-4428
US

IV. Provider business mailing address

14455 SW ALLEN BLVD STE 101
BEAVERTON OR
97005-4428
US

V. Phone/Fax

Practice location:
  • Phone: 503-844-2715
  • Fax:
Mailing address:
  • Phone: 503-844-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC229893
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: