Provider Demographics
NPI:1235447244
Name:GOTTHOLM, AMY MARIE (PCD(DONA))
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:GOTTHOLM
Suffix:
Gender:F
Credentials:PCD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CASTLE GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-1674
Mailing Address - Country:US
Mailing Address - Phone:919-380-2100
Mailing Address - Fax:
Practice Address - Street 1:108 CASTLE GARDEN ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-1674
Practice Address - Country:US
Practice Address - Phone:919-380-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula