Provider Demographics
NPI:1770166381
Name:LOREDO, AMBER MARIE (FNP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:LOREDO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:LOREDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:505 SW MILL VIEW WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1289
Mailing Address - Country:US
Mailing Address - Phone:458-315-0314
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 23321
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10087-332
Practice Address - Country:US
Practice Address - Phone:541-848-1378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202102090NP-PP363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202102090NP-PPOtherNP-PP