Healthcare Provider Details

I. General information

NPI: 1992628242
Provider Name (Legal Business Name): M'ILLUMINO NATURAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 SE 11TH AVE STE 272
PORTLAND OR
97202-1063
US

IV. Provider business mailing address

2505 SE 11TH AVE STE 272
PORTLAND OR
97202-1063
US

V. Phone/Fax

Practice location:
  • Phone: 206-290-3461
  • Fax:
Mailing address:
  • Phone: 206-290-3461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARA BOWES
Title or Position: ACUPUNCTURIST AND OWNER
Credential: LAC
Phone: 206-290-3461