Provider Demographics
NPI:1881995165
Name:NAHABEDIAN, ALENA N (LMT)
Entity type:Individual
Prefix:
First Name:ALENA
Middle Name:N
Last Name:NAHABEDIAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2949 SE KELLY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2038
Mailing Address - Country:US
Mailing Address - Phone:503-998-6876
Mailing Address - Fax:
Practice Address - Street 1:2949 SE KELLY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2038
Practice Address - Country:US
Practice Address - Phone:503-998-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7379171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor