Provider Demographics
NPI:1003150236
Name:WOEBKENBERG, FELICITY MICHELLE (MACOM, LAC, RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:FELICITY
Middle Name:MICHELLE
Last Name:WOEBKENBERG
Suffix:
Gender:F
Credentials:MACOM, LAC, RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18957 TERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7956
Mailing Address - Country:US
Mailing Address - Phone:503-407-0686
Mailing Address - Fax:
Practice Address - Street 1:5916 SW NYBERG LN
Practice Address - Street 2:EAST
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9750
Practice Address - Country:US
Practice Address - Phone:503-692-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC157441171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist