Healthcare Provider Details

I. General information

NPI: 1508071242
Provider Name (Legal Business Name): ANJA MIDDELZICK L.AC., LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. ANJA MIDDELVELD

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 SE HARRISON STREET
MILWAUKIE OR
97222
US

IV. Provider business mailing address

3880 SE HARRISON STREET
MILWAUKIE OR
97222
US

V. Phone/Fax

Practice location:
  • Phone: 503-513-4665
  • Fax: 503-513-4663
Mailing address:
  • Phone: 503-513-4665
  • Fax: 503-513-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00694
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: