Provider Demographics
NPI:1548758022
Name:WALZ, AMBER ANNE (ND)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:ANNE
Last Name:WALZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2067 NW LOVEJOY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1515
Mailing Address - Country:US
Mailing Address - Phone:503-222-2322
Mailing Address - Fax:503-974-0954
Practice Address - Street 1:2067 NW LOVEJOY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1515
Practice Address - Country:US
Practice Address - Phone:503-222-2322
Practice Address - Fax:855-576-7253
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND990175F00000X
OR4438175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty