Provider Demographics
NPI:1497404040
Name:HENRY, AMANDA (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8298 WADE RD
Mailing Address - Street 2:
Mailing Address - City:WARRIOR
Mailing Address - State:AL
Mailing Address - Zip Code:35180-3016
Mailing Address - Country:US
Mailing Address - Phone:205-543-0529
Mailing Address - Fax:
Practice Address - Street 1:8298 WADE RD
Practice Address - Street 2:
Practice Address - City:WARRIOR
Practice Address - State:AL
Practice Address - Zip Code:35180-3016
Practice Address - Country:US
Practice Address - Phone:205-902-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-101323163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant