Provider Demographics
NPI:1134368285
Name:AUDREY CZEREW, MSAOM, L.AC. LLC
Entity type:Organization
Organization Name:AUDREY CZEREW, MSAOM, L.AC. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CZEREW
Authorized Official - Suffix:
Authorized Official - Credentials:MSAOM
Authorized Official - Phone:971-230-8726
Mailing Address - Street 1:1313 SE BIDWELL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6021
Mailing Address - Country:US
Mailing Address - Phone:971-230-8726
Mailing Address - Fax:
Practice Address - Street 1:1313 SE BIDWELL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6021
Practice Address - Country:US
Practice Address - Phone:971-230-8726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00995261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center