Individual
AMY KATHERINE HENNINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
421 SW OAK ST, PORTLAND, OR 97204-1817
(503) 988-7458
(503) 988-3015
Mailing address
600 NE 8TH ST, 3RD FLOOR, GRESHAM, OR 97030-7317
(503) 988-5155
(503) 988-5185
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD20700
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096511
—
OR
05
—
132009
—
OR
05
—
22959
—
OR
Enumeration date
07/31/2006
Last updated
08/12/2015
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