Provider Demographics
NPI:1043686504
Name:SWINEHART, AMANDA L (NNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:SWINEHART
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5299 LAKEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5464
Mailing Address - Country:US
Mailing Address - Phone:740-215-1612
Mailing Address - Fax:
Practice Address - Street 1:5299 LAKEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5464
Practice Address - Country:US
Practice Address - Phone:740-215-1612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201506050NP-PP363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care