Provider Demographics
NPI:1598884124
Name:ANDERSEN, LAKSHMI SUSAN (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMI
Middle Name:SUSAN
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SE DOUGLAS ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4426
Mailing Address - Country:US
Mailing Address - Phone:541-574-6000
Mailing Address - Fax:866-405-6511
Practice Address - Street 1:123 SE DOUGLAS ST STE 2
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4426
Practice Address - Country:US
Practice Address - Phone:541-574-6000
Practice Address - Fax:186-640-5651
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1AC01125171100000X
OR1218175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist