Individual
TRACEY DIONA AMLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4340 N INTERSTATE AVE, PORTLAND, OR 97217-3211
(503) 215-1444
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
12645NP
OH
363LF0000X
Family Nurse Practitioner
Primary
201505843NP-PP
OR
363LF0000X
Family Nurse Practitioner
AP60645755
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500699841
—
OR
Enumeration date
09/10/2011
Last updated
07/21/2016
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