MEDICARE: AMBER LYNN VAN WINKLE LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173C00000X	Reflexologist	20386	OR

General Provider Information

NPI Number	:	1174943963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER LYNN VAN WINKLE LMT

Provider Business Mailing Address
First Line	:	235 NE 49TH AVE
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-5015
Country	:	US
Telephone Number	:	541-908-3179
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 NW 185TH AVE
Second Line	:	#100
City	:	PORTLAND
State	:	OR
Zip	:	97229-3492
Country	:	US
Telephone Number	:	503-290-6636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	05/23/2016

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