Individual
KARLY ANDREA KEAHI BANNISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.AC.
Contact information
Practice address
2926 SE 20TH AVE, PORTLAND, OR 97202-2235
(971) 998-7781
Mailing address
2926 SE 20TH AVE, PORTLAND, OR 97202-2235
(971) 998-7781
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
150426
OR
Other
Enumeration date
11/02/2010
Last updated
11/02/2010
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