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General NPI Number Information
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NPI Number | 1821986639
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Entity Type | Organization
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Legal Business Name | GLIMMER ELECTROLYSIS LLC
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 16239 SE MCLOUGHLIN BLVD STE 208
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City | PORTLAND
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State | OR
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Zip | 97267-4654
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Country | US
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Telephone | 971-322-5909
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Fax |
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Provider Business Mailing Address
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Address Line | 13424 SE 169TH AVE APT A112
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City | HAPPY VALLEY
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State | OR
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Zip | 97015-8744
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Country | US
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Telephone | 971-322-5909
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRAYLIN MITCHELL
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Credential |
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Telephone | 971-322-5909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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