Organization
PLUCK GIRL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LANA BLUE ZEITLER LE (ELECTROLYSIS)
(530) 914-7890
Entity
Organization
Contact information
Practice address
2207 NE BROADWAY ST, STE 123, PORTLAND, OR 97232-1693
(503) 914-7890
Mailing address
2207 NE BROADWAY ST, STE 123, PORTLAND, OR 97232-1693
(503) 914-7890
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BAP-E-10174041
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BLUE1024
PLUCKY GIRL LLC
OR
Enumeration date
08/05/2016
Last updated
08/05/2016
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