Provider Demographics
NPI:1083059059
Name:ENLOE, MARGARET GERTRUDE (LAC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:GERTRUDE
Last Name:ENLOE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:TRUDY
Other - Middle Name:
Other - Last Name:ENLOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, MAC
Mailing Address - Street 1:15962 BOONES FERRY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4351
Mailing Address - Country:US
Mailing Address - Phone:503-860-2372
Mailing Address - Fax:
Practice Address - Street 1:15962 BOONES FERRY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4351
Practice Address - Country:US
Practice Address - Phone:503-860-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-05
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC162042171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist