Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1542 | OR |
NPI | 1043425085 |
---|---|
Provider Name | Dr. Amanda Roe |
First Address | Portland, OR 97202-6643 |
Second Address | Portland, OR 97202-6643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2007 |
Last Update Date | 21/03/2010 |