Provider Demographics
NPI:1679845242
Name:WOOLERY, AMANDA MAE (CD(DONA))
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAE
Last Name:WOOLERY
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1162
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-1162
Mailing Address - Country:US
Mailing Address - Phone:909-609-7558
Mailing Address - Fax:
Practice Address - Street 1:134 N 2ND AVE
Practice Address - Street 2:STE C
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6066
Practice Address - Country:US
Practice Address - Phone:909-609-7558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula