Healthcare Provider Details

I. General information

NPI: 1922277847
Provider Name (Legal Business Name): ELIZABETH COLE L.AC, L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 SE MONROE ST SUITE A3
MILWAUKIE OR
97222-7646
US

IV. Provider business mailing address

2403 SE MONROE ST SUITE A3
MILWAUKIE OR
97222-7646
US

V. Phone/Fax

Practice location:
  • Phone: 503-860-8998
  • Fax: 503-236-8224
Mailing address:
  • Phone: 503-860-8998
  • Fax: 503-236-8224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01153
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: