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General NPI Number Information
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NPI Number | 1659653277
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Entity Type | Individual
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Provider Name | TRACEY DIONA AMLIN FNP
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Gender | Female
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Dates
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Enumeration Date | 09/10/2011
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 4340 N INTERSTATE AVE
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City | PORTLAND
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State | OR
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Zip | 97217-3211
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Country | US
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Telephone | 503-215-1444
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3158
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City | PORTLAND
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State | OR
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Zip | 97208-3158
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12645NP
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201505843NP-PP
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP60645755
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License Number State | WA
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