Provider Demographics
NPI:1386075463
Name:WERLE, JEANNE MARE (LAC)
Entity type:Individual
Prefix:
First Name:JEANNE MARE
Middle Name:
Last Name:WERLE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 CEDAR CREEK RD.
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:WA
Mailing Address - Zip Code:98610
Mailing Address - Country:US
Mailing Address - Phone:503-915-5666
Mailing Address - Fax:
Practice Address - Street 1:415 NE BIRCH ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2139
Practice Address - Country:US
Practice Address - Phone:360-851-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60402517171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist