Healthcare Provider Details

I. General information

NPI: 1669942561
Provider Name (Legal Business Name): AMANDA PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 301
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

602 E NOB HILL BLVD
YAKIMA WA
98901-3534
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-1854
  • Fax: 360-514-6063
Mailing address:
  • Phone: 509-248-3334
  • Fax: 509-453-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60925818
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: