Provider Demographics
NPI:1750603957
Name:HAYMAN, AMANDA VERIENNA (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:VERIENNA
Last Name:HAYMAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:4805 NE GLISAN ST
Practice Address - Street 2:SUITE 6N60
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2933
Practice Address - Country:US
Practice Address - Phone:503-281-0561
Practice Address - Fax:503-416-7377
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125051603208600000X
MN106905208C00000X
MN56908208C00000X
ORMD167212208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038697Medicaid
OR500675150Medicaid
IAENROLLEDMedicaid
MNENROLLEDMedicaid
MN280000173Medicare PIN
ORP01416259Medicare PIN
OR176233Medicare PIN