Provider Demographics
NPI:1124205687
Name:FISK, ANDREA PATON (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:PATON
Last Name:FISK
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 1:3701 SE MILWAUKIE AVE
Mailing Address - Street 2:STE G
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3835
Mailing Address - Country:US
Mailing Address - Phone:971-344-3393
Mailing Address - Fax:503-296-2625
Practice Address - Street 1:3701 SE MILWAUKIE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3835
Practice Address - Country:US
Practice Address - Phone:971-344-3393
Practice Address - Fax:503-296-2625
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01015171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist