Provider Demographics
NPI:1396252458
Name:ALLEN, LIANA MARIE (LAC, MACOM)
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LAC, MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 NE SANDY BLVD APT 30
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3806
Mailing Address - Country:US
Mailing Address - Phone:928-322-9598
Mailing Address - Fax:
Practice Address - Street 1:2250 NW FLANDERS ST STE 304
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5411
Practice Address - Country:US
Practice Address - Phone:928-322-9598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist