MEDICARE: CARRIE MARIE BRISBINE

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	171100000X	Acupuncturist	AC187383	OR

General Provider Information

NPI Number	:	1801445648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE MARIE BRISBINE

Provider Business Mailing Address
First Line	:	7650 SW JOSHUA PL
Second Line	:
City	:	GASTON
State	:	OR
Zip	:	97119-9115
Country	:	US
Telephone Number	:	971-930-2127
Fax Number	:

Provider Business Practice Location Address
First Line	:	30860 NW PACIFIC ST
Second Line	:
City	:	NORTH PLAINS
State	:	OR
Zip	:	97133-8250
Country	:	US
Telephone Number	:	971-930-2127
Fax Number	:

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

Provider Enumeration Date	:	09/04/2019
Last Update Date	:	01/26/2024

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Directions to “ CARRIE MARIE BRISBINE ” Practice Location

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