Provider Demographics
NPI:1568583730
Name:CRONEN, LUCILLE MARIE (LAC)
Entity Type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:MARIE
Last Name:CRONEN
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 1:19990 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2045
Mailing Address - Country:US
Mailing Address - Phone:541-420-2550
Mailing Address - Fax:541-312-2122
Practice Address - Street 1:19990 BIRCHWOOD DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2045
Practice Address - Country:US
Practice Address - Phone:541-420-2550
Practice Address - Fax:541-312-2122
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000753171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist