Provider Demographics
NPI:1659499127
Name:AERENSON, JANE EY (OMD, LAC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:EY
Last Name:AERENSON
Suffix:
Gender:F
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:JEYA
Other - Middle Name:
Other - Last Name:AERENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OMD, LAC
Mailing Address - Street 1:770 W 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2425
Mailing Address - Country:US
Mailing Address - Phone:541-686-1515
Mailing Address - Fax:
Practice Address - Street 1:492 W BROADWAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2834
Practice Address - Country:US
Practice Address - Phone:541-686-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00725171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist