Provider Demographics
NPI:1174943963
Name:VAN WINKLE, AMBER LYNN (LMT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:VAN WINKLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LYNN
Other - Last Name:CAIRNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:235 NE 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5015
Mailing Address - Country:US
Mailing Address - Phone:541-908-3179
Mailing Address - Fax:
Practice Address - Street 1:3220 NW 185TH AVE
Practice Address - Street 2:#100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-3492
Practice Address - Country:US
Practice Address - Phone:503-290-6636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20386173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist