Individual
AMY B ANDERSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
403 SW DENNIS AVE, HILLSBORO, OR 97123-3928
(503) 640-3803
(503) 640-3805
Mailing address
2415 14TH AVE, FOREST GROVE, OR 97116-2805
(503) 992-2471
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1047216
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8383351005
BLUE CROSS BLUE SHIELD
OR
Enumeration date
12/15/2005
Last updated
07/08/2007
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