Provider Demographics
NPI:1093349490
Name:HOMER-BROWN, AMY NICOLE (MBBS, MSOM, LAC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:HOMER-BROWN
Suffix:
Gender:F
Credentials:MBBS, MSOM, LAC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:NICOLE
Other - Last Name:HOMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS, MSOM, LAC
Mailing Address - Street 1:5885 SW MACADAM AVE APT 2204
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3794
Mailing Address - Country:US
Mailing Address - Phone:503-308-8676
Mailing Address - Fax:
Practice Address - Street 1:630 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2623
Practice Address - Country:US
Practice Address - Phone:503-308-8676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC196466171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist