Healthcare Provider Details

I. General information

NPI: 1528756848
Provider Name (Legal Business Name): AMANDA UNDERWOOD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 NW LARCH AVE
REDMOND OR
97756-1357
US

IV. Provider business mailing address

PO BOX 6095
BEND OR
97708-6095
US

V. Phone/Fax

Practice location:
  • Phone: 541-548-2164
  • Fax: 541-548-0534
Mailing address:
  • Phone: 541-706-5922
  • Fax: 541-706-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number201808428RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10011435
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: