Provider Demographics
NPI:1144418708
Name:PARSON, ANGELA (LAC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PARSON
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 1:5423 NE 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-8044
Mailing Address - Country:US
Mailing Address - Phone:971-235-9189
Mailing Address - Fax:
Practice Address - Street 1:2304 E BURNSIDE ST STE 6
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1677
Practice Address - Country:US
Practice Address - Phone:971-235-9189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
ORAC00506171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WDBBBMedicare PIN