Individual
MRS. LANA BLUE ZEITLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LE
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
Enumeration date
08/15/2016
Last updated
08/15/2016
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