Healthcare Provider Details

I. General information

NPI: 1881503043
Provider Name (Legal Business Name): AMANDA VITAL CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6170 SULPHUR MOUNTAIN RD
HARRISON AR
72601-7062
US

IV. Provider business mailing address

6170 SULPHUR MOUNTAIN RD
HARRISON AR
72601-7062
US

V. Phone/Fax

Practice location:
  • Phone: 503-779-8407
  • Fax:
Mailing address:
  • Phone: 503-779-8407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number1500750
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: