Individual
JOLEEN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
5128 NE 42ND AVE, PORTLAND, OR 97218-1506
(503) 347-3948
Mailing address
5128 NE 42ND AVE, PORTLAND, OR 97218-1506
(503) 347-3948
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC192063
OR
Other
Enumeration date
04/24/2019
Last updated
04/24/2019
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