Provider Demographics
NPI:1306901343
Name:BROSE MENDENHALL, AMY (LAC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BROSE MENDENHALL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20510 SW ROY ROGERS RD
Mailing Address - Street 2:BUILDING A, SUITE 100
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9319
Mailing Address - Country:US
Mailing Address - Phone:503-810-5333
Mailing Address - Fax:503-906-3586
Practice Address - Street 1:20510 SW ROY ROGERS RD
Practice Address - Street 2:BUILDING A, SUITE 100
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9319
Practice Address - Country:US
Practice Address - Phone:503-810-5333
Practice Address - Fax:503-906-3586
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00819171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist