Provider Demographics
NPI:1174298582
Name:GATIA, AMANDA MARY (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARY
Last Name:GATIA
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1899 SQUIRREL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1145
Mailing Address - Country:US
Mailing Address - Phone:248-561-3875
Mailing Address - Fax:
Practice Address - Street 1:1899 SQUIRREL VALLEY DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-1145
Practice Address - Country:US
Practice Address - Phone:248-561-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL-157651163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty