Provider Demographics
NPI:1821130469
Name:NASMAN, KERRIE LOREEN (LAC)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:LOREEN
Last Name:NASMAN
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 1:3315 SE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2858
Mailing Address - Country:US
Mailing Address - Phone:503-236-6582
Mailing Address - Fax:
Practice Address - Street 1:2305 SE WASHINGTON ST
Practice Address - Street 2:#110
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7647
Practice Address - Country:US
Practice Address - Phone:503-380-6582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00659171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist