Individual
AMANDA NICOLE CANTU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
727 W BURNSIDE ST, PORTLAND, OR 97209-3514
(503) 228-4533
Mailing address
232 NW 6TH AVENUE, ATTN: CREDENTIALING, PORTLAND, OR 97209
(503) 294-1681
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201709140LPN
OR
Other
Enumeration date
08/14/2018
Last updated
08/14/2018
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