Healthcare Provider Details

I. General information

NPI: 1366886293
Provider Name (Legal Business Name): ANGELA AMUNDSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA ESTEP FNP

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9775 SE SUNNYSIDE RD SUITE 200
CLACKAMAS OR
97015-5739
US

IV. Provider business mailing address

619 NW 6TH AVE
PORTLAND OR
97209-3964
US

V. Phone/Fax

Practice location:
  • Phone: 503-655-8471
  • Fax: 503-723-4907
Mailing address:
  • Phone: 503-988-7468
  • Fax: 503-988-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201142795RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201508262NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: