Healthcare Provider Details

I. General information

NPI: 1114585551
Provider Name (Legal Business Name): PORTLAND WOMEN'S ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4716 SE BELMONT ST
PORTLAND OR
97215-1737
US

IV. Provider business mailing address

4716 SE BELMONT ST
PORTLAND OR
97215-1737
US

V. Phone/Fax

Practice location:
  • Phone: 503-869-3236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELENA MEJIA
Title or Position: NURSE PRACTITIONER/ACUPUNCTURIST
Credential: FNP, LAC
Phone: 503-869-3236