Provider Demographics
NPI:1649424326
Name:PETRAS, LORI MICHELE (LAC; MAOM)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MICHELE
Last Name:PETRAS
Suffix:
Gender:F
Credentials:LAC; MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 NE SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-8071
Mailing Address - Country:US
Mailing Address - Phone:503-753-4402
Mailing Address - Fax:
Practice Address - Street 1:3922 NE SUMNER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-8071
Practice Address - Country:US
Practice Address - Phone:503-753-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist