Provider Demographics
NPI:1033198999
Name:MALENFANT, AMANDA (TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MALENFANT
Suffix:
Gender:F
Credentials:TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMDT (CG-1122) U.S. COAST GUARD
Mailing Address - Street 2:2100 2NS ST. SW, SUITE 5314
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:757-483-8596
Mailing Address - Fax:757-483-8610
Practice Address - Street 1:COMDT (CG-1122) U.S. COAST GUARD
Practice Address - Street 2:2100 2NS ST. SW, SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:757-483-8596
Practice Address - Fax:757-483-8610
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA24720000XOtherTECHNICIAN