Provider Demographics
NPI:1013522119
Name:PREMORE, VALERIE A (MBA, PMP, CCRP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
Last Name:PREMORE
Suffix:
Gender:F
Credentials:MBA, PMP, CCRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 NW 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1607
Mailing Address - Country:US
Mailing Address - Phone:503-939-8205
Mailing Address - Fax:
Practice Address - Street 1:1320 NW 20TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1607
Practice Address - Country:US
Practice Address - Phone:503-939-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturist