Provider Demographics
NPI:1417026410
Name:SHIELDS, AMANDA J (ANP-PP)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:J
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:ANP-PP
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:J
Other - Last Name:THOMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-PP
Mailing Address - Street 1:5100 S MACADAM AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3827
Mailing Address - Country:US
Mailing Address - Phone:971-202-5500
Mailing Address - Fax:971-202-5555
Practice Address - Street 1:5100 S MACADAM AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3827
Practice Address - Country:US
Practice Address - Phone:971-202-5500
Practice Address - Fax:971-202-5555
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-220363LA2200X
OR200850093NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0220317OtherHMSA
HI5019444OtherUHA
HI550196 02Medicaid
HI550196 02Medicaid
HI00A0220317OtherHMSA