Healthcare Provider Details

I. General information

NPI: 1457476178
Provider Name (Legal Business Name): BONNIE ARENT LORENZ L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 SW WASHINGTON AVE
CORVALLIS OR
97333-4405
US

IV. Provider business mailing address

456 SW WASHINGTON AVE
CORVALLIS OR
97333-4405
US

V. Phone/Fax

Practice location:
  • Phone: 541-758-9334
  • Fax: 541-758-1334
Mailing address:
  • Phone: 541-758-9334
  • Fax: 541-758-1334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC000235
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: