Provider Demographics
NPI:1841755311
Name:WESTERN, AMANDA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WESTERN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10226 INDIAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-9101
Mailing Address - Country:US
Mailing Address - Phone:225-907-2781
Mailing Address - Fax:
Practice Address - Street 1:10226 INDIAN CREEK DR
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-9101
Practice Address - Country:US
Practice Address - Phone:225-907-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN120330163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant