Healthcare Provider Details

I. General information

NPI: 1174782189
Provider Name (Legal Business Name): AMANDA L ROE RN, BSN, CNOR, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 6TH AVE SW
ALBANY OR
97321-1916
US

IV. Provider business mailing address

1121 8TH AVE SW
ALBANY OR
97321-2055
US

V. Phone/Fax

Practice location:
  • Phone: 541-926-4000
  • Fax:
Mailing address:
  • Phone: 541-979-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number200242817
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: