Provider Demographics
NPI:1811915309
Name:NEWELL, MICHELLE LOUISE (LAC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LOUISE
Last Name:NEWELL
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 1:4047 SE MAIN ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4457
Mailing Address - Country:US
Mailing Address - Phone:503-236-9495
Mailing Address - Fax:
Practice Address - Street 1:4047 SE MAIN ST
Practice Address - Street 2:APT. 1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4457
Practice Address - Country:US
Practice Address - Phone:503-236-9495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00544171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1811915309OtherCOMPLEMENTARY HEALTH PLAN
OR819958000OtherREGENC - EVICORE