Provider Demographics
NPI:1699387126
Name:CARREON, BRITNEY ANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:BRITNEY
Middle Name:ANN
Last Name:CARREON
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 1:3253 SW NEWBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-8952
Mailing Address - Country:US
Mailing Address - Phone:541-279-0733
Mailing Address - Fax:
Practice Address - Street 1:1397 NW 6TH ST BLDG 19A
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1433
Practice Address - Country:US
Practice Address - Phone:541-279-0733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20778225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR93029OtherPACIFIC SOURCE HEALTH PLAN