Provider Demographics
NPI:1487982666
Name:MEHLHOFF, AMANDA MARY (FNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARY
Last Name:MEHLHOFF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SE JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:OR
Mailing Address - Zip Code:97378-1924
Mailing Address - Country:US
Mailing Address - Phone:503-843-4909
Mailing Address - Fax:503-843-4216
Practice Address - Street 1:222 SE JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:OR
Practice Address - Zip Code:97378-1924
Practice Address - Country:US
Practice Address - Phone:503-843-4909
Practice Address - Fax:503-843-4216
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200841184RN163W00000X
OR201404303NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse