MEDICARE: MISS EMDEN ROSE GRIFFIN L.AC., 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
1	174400000X	Specialist	10489	OR
2	171100000X	Acupuncturist	164966	OR

General Provider Information

NPI Number	:	1659568756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EMDEN ROSE GRIFFIN L.AC., LMT

Provider Business Mailing Address
First Line	:	911 NE 4TH ST STE 2
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4647
Country	:	US
Telephone Number	:	541-350-0723
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 NE 4TH ST STE 2
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4647
Country	:	US
Telephone Number	:	541-350-0723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	06/19/2014

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Directions to “ MISS EMDEN ROSE GRIFFIN L.AC., LMT” Practice Location

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