Provider Demographics
NPI:1689716995
Name:VERMEESCH, AMBER L (PHD, MSN, FNP-C, RN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:VERMEESCH
Suffix:
Gender:F
Credentials:PHD, MSN, FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 NE HALSEY ST.
Mailing Address - Street 2:BLDG 2, SUITE 400
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213
Mailing Address - Country:US
Mailing Address - Phone:425-525-3395
Mailing Address - Fax:
Practice Address - Street 1:4400 NE HALSEY ST
Practice Address - Street 2:BLDG 2, SUITE 400
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1545
Practice Address - Country:US
Practice Address - Phone:425-525-3395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704285068363LF0000X
OR201403724NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4159477OtherBLUE CROSS
TN4176429OtherBLUE CROSS
TN33477221Medicaid
TN4159484OtherBLUE CROSS
TNRN0000152041OtherRN LICENSE
TN33477221OtherMEDICARE