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General NPI Number Information
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NPI Number | 1104648872
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Entity Type | Individual
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Provider Name | SHANA LEVIN LAC
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Gender | Female
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 105 NE 3RD ST
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City | MCMINNVILLE
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State | OR
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Zip | 97128-4948
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Country | US
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Telephone | 701-866-9107
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Fax |
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Provider Business Mailing Address
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Address Line | 748 JOEL PALMER WAY
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City | DAYTON
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State | OR
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Zip | 97114-7804
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Country | US
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Telephone | 701-866-9107
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC222453
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License Number State | OR
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