Provider Demographics
NPI:1619740370
Name:HEYNE, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:HEYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 NW 4TH ST APT 46
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-1768
Mailing Address - Country:US
Mailing Address - Phone:541-709-3629
Mailing Address - Fax:
Practice Address - Street 1:1052 SW 4TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2100
Practice Address - Country:US
Practice Address - Phone:541-216-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist