Provider Demographics
NPI:1245062983
Name:CORWIN, AMELIA LANDIS (RN)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:LANDIS
Last Name:CORWIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-5707
Mailing Address - Country:US
Mailing Address - Phone:503-717-3480
Mailing Address - Fax:
Practice Address - Street 1:383 ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-5707
Practice Address - Country:US
Practice Address - Phone:503-717-3480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61087949163WG0600X
OR201903835RN163WP0809X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult