Individual
ANNIKEN MOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2935 MARINE DR, ASTORIA, OR 97103-2831
(503) 821-9514
Mailing address
1828 NW MILLER RD, PORTLAND, OR 97229-7505
(503) 821-9514
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12061
OR
Other
Enumeration date
01/17/2014
Last updated
01/17/2014
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