Provider Demographics
NPI:1851462808
Name:JOHNSON, AMY BETH (ND)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:BETH
Last Name:JOHNSON
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 1:4031 SE HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5243
Mailing Address - Country:US
Mailing Address - Phone:503-246-8282
Mailing Address - Fax:503-501-3153
Practice Address - Street 1:4031 SE HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5243
Practice Address - Country:US
Practice Address - Phone:503-246-8282
Practice Address - Fax:503-501-3153
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1402175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath