Healthcare Provider Details

I. General information

NPI: 1841897550
Provider Name (Legal Business Name): WOVEN WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6511 N INTERSTATE AVE
PORTLAND OR
97217-4835
US

IV. Provider business mailing address

6511 N INTERSTATE AVE
PORTLAND OR
97217-4835
US

V. Phone/Fax

Practice location:
  • Phone: 503-433-5702
  • Fax: 503-878-8539
Mailing address:
  • Phone: 503-433-5702
  • Fax: 503-878-8539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DEVAN LAURA TORBERT
Title or Position: CO-OWNER
Credential: LAC
Phone: 503-433-5702