Provider Demographics
NPI:1295071496
Name:VANSANT, AMANDA (PA-C)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:VANSANT
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 1:702 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-3121
Mailing Address - Country:US
Mailing Address - Phone:541-889-9167
Mailing Address - Fax:541-889-7873
Practice Address - Street 1:702 SUNSET DR
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914
Practice Address - Country:US
Practice Address - Phone:541-889-9167
Practice Address - Fax:541-889-7873
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA1233363A00000X
ORPA160191363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant