Individual
MACKENNA RAE MASTRUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
2939 SW SPRING GARDEN ST, PORTLAND, OR 97219-3946
(971) 350-9148
Mailing address
2939 SW SPRING GARDEN ST, PORTLAND, OR 97219-3946
(971) 350-9148
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC209770
OR
Other
Enumeration date
03/30/2022
Last updated
03/30/2022
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