Healthcare Provider Details

I. General information

NPI: 1295277622
Provider Name (Legal Business Name): AMANDA RUTH NIELSEN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NE 65TH AVE
VANCOUVER WA
98661-6812
US

IV. Provider business mailing address

14753 SW CATALINA DR
PORTLAND OR
97223-0680
US

V. Phone/Fax

Practice location:
  • Phone: 360-952-3535
  • Fax:
Mailing address:
  • Phone: 503-869-5846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number030867
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number030867
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: