Provider Demographics
NPI:1023224532
Name:BROOK, ANNA (L AC)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:BROOK
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 NE 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2518
Mailing Address - Country:US
Mailing Address - Phone:503-515-5316
Mailing Address - Fax:503-235-3768
Practice Address - Street 1:3125 NE HOLLADAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2504
Practice Address - Country:US
Practice Address - Phone:503-515-5316
Practice Address - Fax:503-235-3768
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00587171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist