Individual
AMANDA NICOLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
485 WAGON WHEEL DR, LEBANON, OR 97355-3745
(541) 337-0376
Mailing address
485 WAGON WHEEL DR, LEBANON, OR 97355-3745
(541) 337-0376
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20133064LPN
OR
Other
Enumeration date
04/16/2013
Last updated
04/16/2013
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