Provider Demographics
NPI:1831643105
Name:O'HALA, AMANDA MARGARET (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARGARET
Last Name:O'HALA
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 1:330 S GARDEN WAY STE 350
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8179
Mailing Address - Country:US
Mailing Address - Phone:631-434-5475
Mailing Address - Fax:
Practice Address - Street 1:330 S GARDEN WAY STE 350
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8179
Practice Address - Country:US
Practice Address - Phone:541-746-6816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3727363AS0400X
ORPA186127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical