Provider Demographics
NPI:1871191239
Name:WINTER, AMY N (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:N
Last Name:WINTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 DIVISION ST STE 105
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1584
Mailing Address - Country:US
Mailing Address - Phone:503-905-4104
Mailing Address - Fax:503-656-9464
Practice Address - Street 1:1508 DIVISION ST STE 105
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1584
Practice Address - Country:US
Practice Address - Phone:503-656-9464
Practice Address - Fax:503-656-9464
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61114824363AM0700X
ORPA208700363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1178698OtherNCCPA
ORPA208700OtherPA-C