Individual
MS. JENNIFER NORITA WIESERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4239 NE 79TH AVE, PORTLAND, OR 97218-4203
(458) 205-4126
Mailing address
4239 NE 79TH AVE, PORTLAND, OR 97218-4203
(458) 205-4126
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
26213
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
454500222
—
OR
Enumeration date
02/09/2022
Last updated
02/09/2022
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