Provider Demographics
NPI:1700918364
Name:ALBANESE, GINA (LAC)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:
Last Name:ALBANESE
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:PO BOX 68056
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97268-0056
Mailing Address - Country:US
Mailing Address - Phone:503-358-7454
Mailing Address - Fax:
Practice Address - Street 1:9828 E BURNSIDE ST STE 250
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2365
Practice Address - Country:US
Practice Address - Phone:503-358-7454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00641171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist