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NPI Code Detail

MEDICARE: MRS. VALERIE JANE FERGUSON LAC, LMT

MEDICARE: MRS. VALERIE JANE FERGUSON LAC, LMT
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
1171100000XAcupuncturist

General Provider Information

NPI Number : 1396860557
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. VALERIE JANE FERGUSON LAC, LMT
Provider Business Mailing Address
First Line : 8709 SW 11TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97219-4320
Country : US
Telephone Number : 503-740-7045
Fax Number :
Provider Business Practice Location Address
First Line : 1750 SW SKYLINE BLVD
Second Line : SUITE 101
City : PORTLAND
State : OR
Zip : 97221-2533
Country : US
Telephone Number : 503-740-7045
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 07/08/2007

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