Provider Demographics
NPI:1144662214
Name:VANADELSBERG, MARIKA JOANNA
Entity type:Individual
Prefix:MS
First Name:MARIKA
Middle Name:JOANNA
Last Name:VANADELSBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12511 SW 68TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8510
Mailing Address - Country:US
Mailing Address - Phone:503-308-3296
Mailing Address - Fax:
Practice Address - Street 1:12511 SW 68TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8510
Practice Address - Country:US
Practice Address - Phone:503-308-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program