Provider Demographics
NPI:1780014530
Name:LARUE, AMY (ND)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:LARUE
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 1:202 SEABROOK DR.
Mailing Address - Street 2:
Mailing Address - City:WAVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39576
Mailing Address - Country:US
Mailing Address - Phone:503-896-9575
Mailing Address - Fax:
Practice Address - Street 1:1009 BENIGNO LANE
Practice Address - Street 2:
Practice Address - City:BAY ST. LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520
Practice Address - Country:US
Practice Address - Phone:228-207-1091
Practice Address - Fax:228-533-2400
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0134077175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath