Provider Demographics
NPI:1447282751
Name:FIELDER, ANN (LAC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:FIELDER
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 1:637 HOLTON RD
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-9726
Mailing Address - Country:US
Mailing Address - Phone:541-488-1767
Mailing Address - Fax:541-482-1739
Practice Address - Street 1:153 CLEAR CREEK DR
Practice Address - Street 2:STE 101
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1880
Practice Address - Country:US
Practice Address - Phone:541-488-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00379171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR295435Medicaid