Individual
AMY C BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1510 DIVISION ST, SUITE 200, OREGON CITY, OR 97045-1581
(503) 650-6880
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1031913
MO
363A00000X
Physician Assistant
Primary
PA163381
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500663461
—
OR
Enumeration date
07/03/2007
Last updated
01/13/2016
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