Healthcare Provider Details

I. General information

NPI: 1821354424
Provider Name (Legal Business Name): NATHAN FRANKLIN AMRINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 160
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

2111 EXCHANGE ST DEPT. OF OB/GYN
ASTORIA OR
97103-3329
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-1060
  • Fax: 360-514-1065
Mailing address:
  • Phone: 503-338-7536
  • Fax: 503-338-7537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD175268
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD61060910
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: