Provider Demographics
NPI:1225326465
Name:DEARDORFF, AMANDA MARIE (CNM, ARNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:DEARDORFF
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 5TH AVE NE STE 102
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4171
Mailing Address - Country:US
Mailing Address - Phone:425-366-7563
Mailing Address - Fax:425-671-0360
Practice Address - Street 1:2511 NE 100TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7707
Practice Address - Country:US
Practice Address - Phone:425-366-7563
Practice Address - Fax:425-671-0360
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60239525367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife