Individual
DR. MIA MARIN- PECK CRUPPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.D., L.M.T
Contact information
Practice address
4259 NE BROADWAY ST, PORTLAND, OR 97213-1421
(503) 235-2259
Mailing address
4259 NE BROADWAY ST, PORTLAND, OR 97213-1421
(503) 235-2259
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
7621
OR
175F00000X
Naturopath
Primary
1481
OR
176B00000X
Midwife
—
—
374J00000X
Doula
—
—
Other
Enumeration date
03/21/2007
Last updated
02/07/2012
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