=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689762064
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER NADINE SLAUGHTER LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 03/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 17TH ST STE 5
-----------------------------------------------------
City | OREGON CITY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97045-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-544-5067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15915 S BOULDER DR
-----------------------------------------------------
City | MULINO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97042-9755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-632-5733
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC00521
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------