Provider Demographics
NPI:1356052344
Name:WHITE, AMETHYST (FNP-C)
Entity type:Individual
Prefix:
First Name:AMETHYST
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 SALEM HEIGHTS AVE S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5602
Mailing Address - Country:US
Mailing Address - Phone:541-714-0736
Mailing Address - Fax:
Practice Address - Street 1:617 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2312
Practice Address - Country:US
Practice Address - Phone:503-476-1431
Practice Address - Fax:855-247-1666
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10002342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily