Individual
AMY VIDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22518 S PARROT CREEK RD, OREGON CITY, OR 97045-9725
(503) 266-3050
(503) 266-4793
Mailing address
22518 S PARROT CREEK RD, OREGON CITY, OR 97045-9725
(503) 266-3050
(503) 266-4793
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104253079
—
OR
Enumeration date
11/09/2016
Last updated
11/09/2016
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