Provider Demographics
NPI:1891830949
Name:BADER, AMY NOEL (ND)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:NOEL
Last Name:BADER
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 1:7025 NE 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5246
Mailing Address - Country:US
Mailing Address - Phone:503-247-8110
Mailing Address - Fax:503-232-3436
Practice Address - Street 1:2304 E BURNSIDE ST STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1689
Practice Address - Country:US
Practice Address - Phone:503-236-6006
Practice Address - Fax:503-232-3436
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1044175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath