Healthcare Provider Details

I. General information

NPI: 1821130469
Provider Name (Legal Business Name): KERRIE LOREEN NASMAN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 SE WASHINGTON ST #110
MILWAUKIE OR
97222-7647
US

IV. Provider business mailing address

3315 SE 16TH AVE
PORTLAND OR
97202-2858
US

V. Phone/Fax

Practice location:
  • Phone: 503-380-6582
  • Fax:
Mailing address:
  • Phone: 503-236-6582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00659
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: