Provider Demographics
NPI:1568418044
Name:TOENGI, AMY A (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:TOENGI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:A
Other - Last Name:ROUNSAVELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:421 SW OAK ST
Mailing Address - Street 2:STE.210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1817
Mailing Address - Country:US
Mailing Address - Phone:503-988-3663
Mailing Address - Fax:503-988-3015
Practice Address - Street 1:5210 N KERBY AVE
Practice Address - Street 2:BASEMENT
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2656
Practice Address - Country:US
Practice Address - Phone:503-988-3360
Practice Address - Fax:503-988-5780
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550133NP FNP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR242009Medicaid
ORR0000WCJHTMedicare Oscar/Certification
ORR162252Medicare PIN