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NPI Code Detail

MEDICARE: MISS MELODY LYNNE SHORT L.AC.

MEDICARE: MISS MELODY LYNNE SHORT L.AC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturist00906OR

General Provider Information

NPI Number : 1134257991
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MELODY LYNNE SHORT L.AC.
Provider Business Mailing Address
First Line : 3811 E MCLOUGHLIN BLVD
Second Line :
City : VANCOUVER
State : WA
Zip : 98661-5451
Country : US
Telephone Number : 503-422-6473
Fax Number :
Provider Business Practice Location Address
First Line : 2232 NW PETTYGROVE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97210-2608
Country : US
Telephone Number : 503-552-1552
Fax Number : 503-827-8460
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 07/08/2007

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Directions to “ MISS MELODY LYNNE SHORT L.AC.” Practice Location

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