Provider Demographics
NPI:1548560451
Name:AMUNDSEN, TONI MARIE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:MARIE
Last Name:AMUNDSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35070 WILLOW SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-5936
Mailing Address - Country:US
Mailing Address - Phone:909-797-6607
Mailing Address - Fax:
Practice Address - Street 1:2016 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-3914
Practice Address - Country:US
Practice Address - Phone:909-881-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1915367A00000X
CA389481367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife