Individual
AMANDA JEANNE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
828 14TH ST, ASTORIA, OR 97103-3928
(503) 739-0619
Mailing address
828 14TH ST, ASTORIA, OR 97103-3928
(503) 739-0619
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10017884
OR
Other
Enumeration date
10/30/2023
Last updated
10/30/2023
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