Provider Demographics
NPI:1790123800
Name:NORTHRUP, AMARKAUR (LAC)
Entity Type:Individual
Prefix:MS
First Name:AMARKAUR
Middle Name:
Last Name:NORTHRUP
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16320 BRYANT RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4308
Mailing Address - Country:US
Mailing Address - Phone:503-344-6880
Mailing Address - Fax:503-744-0420
Practice Address - Street 1:4394 THUNDER VISTA LN
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1851
Practice Address - Country:US
Practice Address - Phone:503-344-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00167171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist