Provider Demographics
NPI:1487873014
Name:BROWN, ANITA B (LAC)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:B
Last Name:BROWN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2829
Mailing Address - Country:US
Mailing Address - Phone:971-804-5500
Mailing Address - Fax:503-523-2180
Practice Address - Street 1:316 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2829
Practice Address - Country:US
Practice Address - Phone:971-804-5500
Practice Address - Fax:503-523-2180
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC160413171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist