Provider Demographics
NPI:1295585917
Name:O'NEILL SMITH, DR. AMBER RENEA (PHD)
Entity type:Individual
Prefix:
First Name:DR. AMBER
Middle Name:RENEA
Last Name:O'NEILL SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-0933
Mailing Address - Country:US
Mailing Address - Phone:503-406-7865
Mailing Address - Fax:
Practice Address - Street 1:465 E CLARENDON ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2433
Practice Address - Country:US
Practice Address - Phone:503-406-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR172V00000X
ORTHW000111083374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty