Healthcare Provider Details

I. General information

NPI: 1720615875
Provider Name (Legal Business Name): AMANDA M. CANARIO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MARIE WOLF DO

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3377 RIVERBEND DR
SPRINGFIELD OR
97477-8803
US

IV. Provider business mailing address

3333 RIVERBEND DR
SPRINGFIELD OR
97477-8800
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-8500
  • Fax: 541-222-6435
Mailing address:
  • Phone: 541-222-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO215184
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: