Healthcare Provider Details

I. General information

NPI: 1386477362
Provider Name (Legal Business Name): AMY SWENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 MOLALLA AVE
OREGON CITY OR
97045-2799
US

IV. Provider business mailing address

18221 SE 23RD ST
VANCOUVER WA
98683-1848
US

V. Phone/Fax

Practice location:
  • Phone: 503-656-9030
  • Fax:
Mailing address:
  • Phone: 360-931-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number201804651RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: