Provider Demographics
NPI:1437340791
Name:MACDONALD, NANCY J (LMT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 SW 198TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-2350
Mailing Address - Country:US
Mailing Address - Phone:503-591-0805
Mailing Address - Fax:503-642-9611
Practice Address - Street 1:3230 SW 198TH AVE
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-2350
Practice Address - Country:US
Practice Address - Phone:503-591-0805
Practice Address - Fax:503-642-9611
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5184225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5184OtherSTATE LICENSE