Provider Demographics
NPI:1720569809
Name:BRANCH, AMANDA (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BRANCH
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 CHEVELLE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7808
Mailing Address - Country:US
Mailing Address - Phone:225-802-3615
Mailing Address - Fax:
Practice Address - Street 1:7941 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3536
Practice Address - Country:US
Practice Address - Phone:225-761-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09896176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife