Provider Demographics
NPI:1689322372
Name:MAURER, AMANDA LYNN (PPD CLC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:MAURER
Suffix:
Gender:F
Credentials:PPD CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 N ELK RUN ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7607
Mailing Address - Country:US
Mailing Address - Phone:304-920-7978
Mailing Address - Fax:
Practice Address - Street 1:2661 N ELK RUN ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7607
Practice Address - Country:US
Practice Address - Phone:304-920-7978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN