Provider Demographics
NPI:1801445648
Name:BRISBINE, CARRIE MARIE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:MARIE
Last Name:BRISBINE
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 1:7650 SW JOSHUA PL
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:OR
Mailing Address - Zip Code:97119-9115
Mailing Address - Country:US
Mailing Address - Phone:971-930-2127
Mailing Address - Fax:
Practice Address - Street 1:30860 NW PACIFIC ST
Practice Address - Street 2:
Practice Address - City:NORTH PLAINS
Practice Address - State:OR
Practice Address - Zip Code:97133-8250
Practice Address - Country:US
Practice Address - Phone:971-930-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC187383171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist