Provider Demographics
NPI:1265818702
Name:PAUL, AMY (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FAIRVIEW HEIGHTS LOOP
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-2324
Mailing Address - Country:US
Mailing Address - Phone:503-724-7654
Mailing Address - Fax:
Practice Address - Street 1:16 FAIRVIEW HEIGHTS LOOP
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-2324
Practice Address - Country:US
Practice Address - Phone:503-724-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200342091RN163W00000X
ORL-68502163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant