Provider Demographics
NPI:1528212289
Name:KNAPP, AMANDA DAWN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:DAWN
Last Name:KNAPP
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:DAWN
Other - Last Name:REAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:946 SE NEHALEM ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6516
Mailing Address - Country:US
Mailing Address - Phone:503-327-8436
Mailing Address - Fax:
Practice Address - Street 1:946 SE NEHALEM ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6516
Practice Address - Country:US
Practice Address - Phone:503-327-8436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01226171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist