Healthcare Provider Details

I. General information

NPI: 1851849954
Provider Name (Legal Business Name): AMANDA M MANNING P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2016
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 NW EDENBOWER BLVD. SUITE 100
ROSEBURG OR
97471-6214
US

IV. Provider business mailing address

1515 VILLAGE DR
COTTAGE GROVE OR
97424-9700
US

V. Phone/Fax

Practice location:
  • Phone: 541-677-7200
  • Fax: 541-229-3309
Mailing address:
  • Phone: 360-729-1253
  • Fax: 541-229-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA188302
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: