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General NPI Number Information
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NPI Number | 1700288669
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Entity Type | Individual
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Provider Name | MALEA MACODRUM N.D., M.S.O.M.
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Gender | Female
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 516 SE MORRISON ST SUITE 207
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City | PORTLAND
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State | OR
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Zip | 97214-2327
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Country | US
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Telephone | 503-239-1022
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Fax | 503-512-5850
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Provider Business Mailing Address
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Address Line | 3718 SE 33RD PL
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City | PORTLAND
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State | OR
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Zip | 97202-3056
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Country | US
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Telephone | 503-754-5397
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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