Individual
LANA KRISTINE WIRGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
210 NW 17TH AVE, PORTLAND, OR 97209-2151
(971) 407-3066
Mailing address
5704 NE MASON ST, PORTLAND, OR 97218-2210
(503) 688-8001
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
15383
OR
Other
Enumeration date
09/12/2017
Last updated
09/12/2017
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