Provider Demographics
NPI:1346431699
Name:DE VRIES, AMANDA K (LMP)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:K
Last Name:DE VRIES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E RIO VISTA
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233
Mailing Address - Country:US
Mailing Address - Phone:360-755-2105
Mailing Address - Fax:360-424-5197
Practice Address - Street 1:301 E RIO VISTA
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233
Practice Address - Country:US
Practice Address - Phone:360-755-2105
Practice Address - Fax:360-424-5197
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022882174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist