Provider Demographics
NPI:1851723878
Name:BALL, AMANDA BLAKENEY (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BLAKENEY
Last Name:BALL
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 CLINTON WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2903
Mailing Address - Country:US
Mailing Address - Phone:303-330-4422
Mailing Address - Fax:
Practice Address - Street 1:2703 CLINTON WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2903
Practice Address - Country:US
Practice Address - Phone:303-330-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0176537163W00000X
COIBCLC 11194957163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse