Individual
AMANDA ST JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3164 NE 35TH PL, PORTLAND, OR 97212-2728
(208) 249-5516
Mailing address
3164 NE 35TH PL, PORTLAND, OR 97212-2728
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201602229NP-PP
OR
Other
Enumeration date
04/07/2016
Last updated
04/07/2016
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