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General NPI Number Information
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NPI Number | 1134368285
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Entity Type | Organization
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Legal Business Name | AUDREY CZEREW, MSAOM, L.AC. LLC
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 1313 SE BIDWELL ST
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City | PORTLAND
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State | OR
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Zip | 97202-6021
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Country | US
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Telephone | 971-230-8726
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Fax |
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Provider Business Mailing Address
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Address Line | 1313 SE BIDWELL ST
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City | PORTLAND
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State | OR
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Zip | 97202-6021
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Country | US
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Telephone | 971-230-8726
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | AUDREY M CZEREW
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Credential | MSAOM
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Telephone | 971-230-8726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AC00995
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License Number State | OR
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