Individual
KIMBERLY ANNE NISTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC.
Contact information
Practice address
1331 SE BIRCH ST, PORTLAND, OR 97214-5335
(503) 309-7267
Mailing address
1331 SE BIRCH ST, PORTLAND, OR 97214-5335
(503) 309-7267
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
00345
OR
Other
Enumeration date
05/04/2007
Last updated
10/02/2015
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