Provider Demographics
NPI:1043425085
Name:ROE, AMANDA (ND)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:ROE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 SE TACOMA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6643
Mailing Address - Country:US
Mailing Address - Phone:503-233-8113
Mailing Address - Fax:503-239-8937
Practice Address - Street 1:1567 SE TACOMA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6643
Practice Address - Country:US
Practice Address - Phone:503-233-8113
Practice Address - Fax:503-239-8937
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2010-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1542175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath