Provider Demographics
NPI:1396861456
Name:NEUSE, MIA M (MILENA NEUSE)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:M
Last Name:NEUSE
Suffix:
Gender:F
Credentials:MILENA NEUSE
Other - Prefix:
Other - First Name:MILENA
Other - Middle Name:
Other - Last Name:NEUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MILENA NEUSE
Mailing Address - Street 1:212 SE 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1515
Mailing Address - Country:US
Mailing Address - Phone:503-539-9180
Mailing Address - Fax:503-459-4183
Practice Address - Street 1:7925 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2341
Practice Address - Country:US
Practice Address - Phone:503-539-9180
Practice Address - Fax:503-467-4127
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00963171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist