Provider Demographics
NPI:1346638178
Name:MACDONALD, AMANDA (LM, CPM)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1724
Mailing Address - Country:US
Mailing Address - Phone:775-525-1669
Mailing Address - Fax:775-313-9615
Practice Address - Street 1:12 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-525-1669
Practice Address - Fax:775-313-9615
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-01
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife