Provider Demographics
NPI:1124168844
Name:OPAL, AMI K (ND)
Entity type:Individual
Prefix:DR
First Name:AMI
Middle Name:K
Last Name:OPAL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:K
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 SE TAYLOR ST
Mailing Address - Street 2:STE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2276
Mailing Address - Country:US
Mailing Address - Phone:971-254-5550
Mailing Address - Fax:
Practice Address - Street 1:117 SE TAYLOR ST
Practice Address - Street 2:STE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2276
Practice Address - Country:US
Practice Address - Phone:971-254-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1204175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath