Provider Demographics
NPI:1073830519
Name:DURNEZ, AMANDA R (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:DURNEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 CASCADE AVE
Mailing Address - Street 2:W-30
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-9751
Mailing Address - Country:US
Mailing Address - Phone:541-399-2354
Mailing Address - Fax:
Practice Address - Street 1:104 5TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2058
Practice Address - Country:US
Practice Address - Phone:541-399-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14725171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor