Healthcare Provider Details

I. General information

NPI: 1164677654
Provider Name (Legal Business Name): JENNIFER MEYERS NETZER L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 NW FLANDERS ST STE. 101
PORTLAND OR
97210
US

IV. Provider business mailing address

3131 SE 65TH AVE
PORTLAND OR
97206-1909
US

V. Phone/Fax

Practice location:
  • Phone: 503-701-8766
  • Fax: 503-241-5484
Mailing address:
  • Phone: 503-475-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLL18207
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: