Individual
MRS. AMY LYNETTE MCILVENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1700 E 19TH ST, THE DALLES, OR 97058-3317
(541) 296-7345
Mailing address
1634 22ND ST, HOOD RIVER, OR 97031-8665
(317) 965-3228
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
28161126A
IN
Other
Enumeration date
10/08/2008
Last updated
10/08/2008
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