Provider Demographics
NPI:1306123542
Name:AISTON, MARY ELIZABETH (LPN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:AISTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:RADMACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8605 SE CLATSOP ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-6511
Mailing Address - Country:US
Mailing Address - Phone:503-784-4174
Mailing Address - Fax:
Practice Address - Street 1:8605 SE CLATSOP ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-6511
Practice Address - Country:US
Practice Address - Phone:503-784-4174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201130574LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse