Provider Demographics
NPI:1821672395
Name:NAMBIAR, AMANDA (CNM, WHNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:NAMBIAR
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13160 JERUSALEM HILL RD NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-9622
Mailing Address - Country:US
Mailing Address - Phone:925-324-2145
Mailing Address - Fax:
Practice Address - Street 1:545 NE 47TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2237
Practice Address - Country:US
Practice Address - Phone:925-324-2145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCNM06851176B00000X
OR104951734363LW0102X
OR202107253NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health