Healthcare Provider Details

I. General information

NPI: 1962750208
Provider Name (Legal Business Name): AMI FLADOOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 11/28/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37400 BELL ST
OREGON CITY OR
97045
US

IV. Provider business mailing address

2051 KAEN RD SUITE 367
OREGON CITY OR
97045-4035
US

V. Phone/Fax

Practice location:
  • Phone: 503-668-3483
  • Fax:
Mailing address:
  • Phone: 503-742-5300
  • Fax: 503-655-8350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201043206RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20200540NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: