Provider Demographics
NPI:1376097709
Name:ZEITLER, LANA BLUE (LE)
Entity type:Individual
Prefix:MRS
First Name:LANA
Middle Name:BLUE
Last Name:ZEITLER
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 NE BROADWAY ST
Mailing Address - Street 2:STE 123
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1693
Mailing Address - Country:US
Mailing Address - Phone:503-914-7890
Mailing Address - Fax:
Practice Address - Street 1:2207 NE BROADWAY ST
Practice Address - Street 2:STE 123
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1693
Practice Address - Country:US
Practice Address - Phone:503-914-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-E-10174041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist