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General NPI Number Information
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NPI Number | 1316446800
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Entity Type | Individual
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Provider Name | MARI ANE ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 02/09/2018
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Last Update Date | 02/09/2018
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Provider Practice Location Address
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Address Line | 1515 NW 23RD AVE
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City | PORTLAND
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State | OR
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Zip | 97210-2617
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Country | US
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Telephone | 971-219-9107
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Fax |
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Provider Business Mailing Address
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Address Line | 2384 NW QUIMBY ST
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City | PORTLAND
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State | OR
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Zip | 97210-2626
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Country | US
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Telephone | 971-219-9107
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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 | 259
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License Number State | OR
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