Provider Demographics
NPI:1609020056
Name:SMITH, AMY ROCHELLE (CNM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ROCHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8428 NE RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-5350
Mailing Address - Country:US
Mailing Address - Phone:503-312-9461
Mailing Address - Fax:
Practice Address - Street 1:8428 NE RUSSELL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5350
Practice Address - Country:US
Practice Address - Phone:503-312-9461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10006238367A00000X
OR201908925RN163WH0200X
ORPENDING367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WH0200XNursing Service ProvidersRegistered NurseHome Health