Provider Demographics
NPI:1538626825
Name:TORBERT, DEVAN LAURA (LAC)
Entity type:Individual
Prefix:
First Name:DEVAN
Middle Name:LAURA
Last Name:TORBERT
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 1:3526 NE 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1737
Mailing Address - Country:US
Mailing Address - Phone:503-335-9440
Mailing Address - Fax:
Practice Address - Street 1:1836 NE 7TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3996
Practice Address - Country:US
Practice Address - Phone:503-433-5702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC190431171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500760087Medicaid