Provider Demographics
NPI:1548854516
Name:VACHERESSE, ANNA BELLE
Entity type:Individual
Prefix:
First Name:ANNA BELLE
Middle Name:
Last Name:VACHERESSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:DRAHOS-VACHERESSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1450 SW JEFFERSON ST APT 511
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-2637
Mailing Address - Country:US
Mailing Address - Phone:503-462-2827
Mailing Address - Fax:
Practice Address - Street 1:913 SW 16TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1730
Practice Address - Country:US
Practice Address - Phone:503-228-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26202225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist