Basic Information
| Provider Information | |||||||||
| NPI: | 1003150236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOEBKENBERG | ||||||||
| FirstName: | FELICITY | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MACOM, LAC, RN, BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18957 TERRY AVE | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970357956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034070686 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5916 SW NYBERG LN | ||||||||
| Address2: | EAST | ||||||||
| City: | TUALATIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970629750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036924934 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2012 | ||||||||
| LastUpdateDate: | 03/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | AC157441 | OR | Y | Other Service Providers | Acupuncturist |
No ID Information.