Provider Demographics
NPI:1154670081
Name:CRESSMAN, AMANDA (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CRESSMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SE GILHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1424
Mailing Address - Country:US
Mailing Address - Phone:503-869-6217
Mailing Address - Fax:
Practice Address - Street 1:13500 SW PACIFIC HWY
Practice Address - Street 2:SUITE 58 PMB 218
Practice Address - City:TIGARD
Practice Address - State:WA
Practice Address - Zip Code:97223-4803
Practice Address - Country:US
Practice Address - Phone:503-869-6217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00176068163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care