Provider Demographics
NPI:1457545204
Name:SURAN, ANNE MARIE (LMT, LMP, NCTMB)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MARIE
Last Name:SURAN
Suffix:
Gender:F
Credentials:LMT, LMP, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 SW BARBUR BLVD
Mailing Address - Street 2:SUITE 119 #227
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5428
Mailing Address - Country:US
Mailing Address - Phone:503-317-3831
Mailing Address - Fax:
Practice Address - Street 1:9220 SW BARBUR BLVD
Practice Address - Street 2:SUITE 119 #227
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5428
Practice Address - Country:US
Practice Address - Phone:503-317-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11601174400000X
WAMA00020332174400000X
41939200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist