Provider Demographics
NPI:1982732517
Name:VERNICK, DEBRA WU (MSOM, LAC)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:WU
Last Name:VERNICK
Suffix:
Gender:F
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11940 SW 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-8269
Mailing Address - Country:US
Mailing Address - Phone:240-888-5804
Mailing Address - Fax:240-888-5804
Practice Address - Street 1:11940 SW 34TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-8269
Practice Address - Country:US
Practice Address - Phone:240-888-5804
Practice Address - Fax:240-888-5804
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC155488171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist