Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 17079 | OR |
NPI | 1013252444 |
---|---|
Provider Name | Miss Anna Nicole Spangler |
First Address | Portland, OR 97229-5314 |
Second Address | Portland, OR 97229-5314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2012 |
Last Update Date | 12/12/2012 |