Provider Demographics
NPI:1053769430
Name:IRELAND, AMEE (STUDENT)
Entity type:Individual
Prefix:
First Name:AMEE
Middle Name:
Last Name:IRELAND
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2306
Mailing Address - Country:US
Mailing Address - Phone:541-733-5774
Mailing Address - Fax:
Practice Address - Street 1:1406 SE 164TH AVE STE 250
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9663
Practice Address - Country:US
Practice Address - Phone:360-940-0810
Practice Address - Fax:888-468-6732
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program