Healthcare Provider Details

I. General information

NPI: 1710312186
Provider Name (Legal Business Name): BONNIE ARENT LORENZ, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 NW 4TH ST
CORVALLIS OR
97330-6415
US

IV. Provider business mailing address

712 NW 4TH ST
CORVALLIS OR
97330-6415
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: MS. BONNIE ARENT LORENZ
Title or Position: OWNER/ACUPUNCTURIST
Credential: L.AC.
Phone: 541-758-9334