Provider Demographics
NPI:1235413840
Name:AMADOR, REBECCA LYNN (MSN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:AMADOR
Suffix:
Gender:F
Credentials:MSN, AGPCNP-BC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:RADENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:875 OAK ST SE STE 4030
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3984
Mailing Address - Country:US
Mailing Address - Phone:503-561-6444
Mailing Address - Fax:
Practice Address - Street 1:875 OAK ST SE STE 4030
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3984
Practice Address - Country:US
Practice Address - Phone:503-561-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3114133V00000X
01025548133V00000X
IDTEMP65519363L00000X
ID65519363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered