Provider Demographics
NPI:1821358284
Name:ABBOTT, AMANDA WARREN (CNM)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:WARREN
Last Name:ABBOTT
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 1:519 WHITNEY AVENUE
Mailing Address - Street 2:APT 1
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-499-3333
Mailing Address - Fax:
Practice Address - Street 1:519 WHITNEY AVENUE
Practice Address - Street 2:APT 1
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-499-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-20
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife