Provider Demographics
NPI:1053658609
Name:VACARELLA, AMITY ROSE (ND)
Entity Type:Individual
Prefix:DR
First Name:AMITY
Middle Name:ROSE
Last Name:VACARELLA
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 1:5007 N PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4464
Mailing Address - Country:US
Mailing Address - Phone:503-960-2914
Mailing Address - Fax:
Practice Address - Street 1:5007 N PRINCETON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4464
Practice Address - Country:US
Practice Address - Phone:503-960-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1947175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath