Healthcare Provider Details

I. General information

NPI: 1124205687
Provider Name (Legal Business Name): ANDREA PATON FISK L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 SE MILWAUKIE AVE
PORTLAND OR
97202-3835
US

IV. Provider business mailing address

3701 SE MILWAUKIE AVE STE G
PORTLAND OR
97202-3835
US

V. Phone/Fax

Practice location:
  • Phone: 971-344-3393
  • Fax: 503-296-2625
Mailing address:
  • Phone: 971-344-3393
  • Fax: 503-296-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01015
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: