Healthcare Provider Details

I. General information

NPI: 1083309538
Provider Name (Legal Business Name): AMANDA JESSICA HARRIGAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 GATEWAY ST
SPRINGFIELD OR
97477-1054
US

IV. Provider business mailing address

3312 GATEWAY ST
SPRINGFIELD OR
97477-1054
US

V. Phone/Fax

Practice location:
  • Phone: 541-246-6606
  • Fax: 541-945-7746
Mailing address:
  • Phone: 541-246-6606
  • Fax: 541-945-7746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10065110
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number819414
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: