Provider Demographics
NPI:1376324541
Name:GIL, AMANDA SQUIRES
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SQUIRES
Last Name:GIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4423 NE 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-8203
Mailing Address - Country:US
Mailing Address - Phone:206-890-4437
Mailing Address - Fax:
Practice Address - Street 1:4423 NE 36TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-8203
Practice Address - Country:US
Practice Address - Phone:206-890-4437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula