Provider Demographics
NPI:1558402255
Name:FELDMANN, AMANDA SUSAN (LM, CPM)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:SUSAN
Last Name:FELDMANN
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 1:401 OLYMPIA AVE NE UNIT 27
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-4119
Mailing Address - Country:US
Mailing Address - Phone:425-235-4674
Mailing Address - Fax:425-235-0125
Practice Address - Street 1:401 OLYMPIA AVE NE STE 246
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-4117
Practice Address - Country:US
Practice Address - Phone:425-235-4674
Practice Address - Fax:425-235-0125
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000259176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7127608Medicaid