Provider Demographics
NPI:1063120368
Name:PATTY MCDUFFEY, LAC
Entity type:Organization
Organization Name:PATTY MCDUFFEY, LAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDUFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:541-420-9222
Mailing Address - Street 1:4445 NE FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1153
Mailing Address - Country:US
Mailing Address - Phone:541-420-9222
Mailing Address - Fax:971-350-3392
Practice Address - Street 1:4445 NE FREMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1153
Practice Address - Country:US
Practice Address - Phone:541-420-9222
Practice Address - Fax:971-350-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center