Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 201506050NP-PP | OR |
NPI | 1043686504 |
---|---|
Provider Name | Mrs. Amanda L Swinehart |
First Address | Lake Oswego, OR 97035-5464 |
Second Address | Lake Oswego, OR 97035-5464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2015 |
Last Update Date | 19/08/2015 |