Healthcare Provider Details

I. General information

NPI: 1518902337
Provider Name (Legal Business Name): AMANDA COLLEEN KRBEC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA COLLEEN THORNTON

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 10/30/2022
Certification Date: 10/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8332 SE 13TH AVE
PORTLAND OR
97202-7102
US

IV. Provider business mailing address

8332 SE 13TH AVE
PORTLAND OR
97202-7102
US

V. Phone/Fax

Practice location:
  • Phone: 503-595-9300
  • Fax:
Mailing address:
  • Phone: 503-595-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-144145
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number543954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: