Provider Demographics
NPI:1427199595
Name:CZEREW, AUDREY MARIE (MSAOM, LAC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:MARIE
Last Name:CZEREW
Suffix:
Gender:F
Credentials:MSAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 SE BIDWELL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6021
Mailing Address - Country:US
Mailing Address - Phone:971-230-8726
Mailing Address - Fax:503-523-2183
Practice Address - Street 1:1313 SE BIDWELL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6021
Practice Address - Country:US
Practice Address - Phone:971-230-8726
Practice Address - Fax:503-523-2183
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00995171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist