Active NPI
Amy Lynette McIlvenna, RN
- Critical Care Medicine Registered Nurse
- The Dalles, OR
National Provider Identifier
1225289267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Care Medicine Registered Nurse
- License
- 28161126A
- Practice address
- 1700 E 19TH St
The Dalles, OR 97058-3317 - Phone
- (541) 296-7345
- NPI assigned
- Oct 8, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine Registered Nurse | 163WC0200X | 28161126A | IN | Primary |
Addresses
Primary practice location
1700 E 19TH St
The Dalles, OR 97058-3317
Mailing address
1634 22ND St
Hood River, OR 97031-8665
Phone (317) 965-3228
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28161126A | IN | MD | Critical Care Medicine Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223424000000",
"number": "1225289267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1634 22ND ST",
"city": "HOOD RIVER",
"state": "OR",
"postal_code": "970318665",
"telephone_number": "317-965-3228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 E 19TH ST",
"city": "THE DALLES",
"state": "OR",
"postal_code": "970583317",
"telephone_number": "541-296-7345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCILVENNA",
"first_name": "AMY",
"middle_name": "LYNETTE",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-08",
"last_updated": "2008-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "163WC0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Critical Care Medicine",
"state": "IN",
"license": "28161126A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in The Dalles, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.