Individual
CRYSTAL DAWN NELLERMOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
357 WARNER MILNE RD, OREGON CITY, OR 97045-4045
(503) 655-6780
Mailing address
357 WARNER MILNE RD, OREGON CITY, OR 97045-4045
(503) 655-6780
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
13223
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13223
OREGON MASSAGE LICENSE
OR
Enumeration date
03/04/2011
Last updated
03/04/2011
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