Provider Demographics
NPI:1073590683
Name:MCELROY, AMY B (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:MCELROY
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 1:340 NW 5TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1869
Mailing Address - Country:US
Mailing Address - Phone:541-526-6635
Mailing Address - Fax:541-526-6636
Practice Address - Street 1:340 NW 5TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1869
Practice Address - Country:US
Practice Address - Phone:541-526-6635
Practice Address - Fax:541-526-6636
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR092000177N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR11132458OtherCAQH ID
ORR158226Medicare PIN
OR500630425Medicaid