Provider Demographics
NPI:1003637406
Name:MCINTOSH, AMY VIOLA (BIRTH & POSTP DOULA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:VIOLA
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:BIRTH & POSTP DOULA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:VIOLA
Other - Last Name:TIPTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BIRTH & POSTP DOULA
Mailing Address - Street 1:55 WESTERN AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3172
Mailing Address - Country:US
Mailing Address - Phone:859-322-2954
Mailing Address - Fax:
Practice Address - Street 1:55 WESTERN AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3172
Practice Address - Country:US
Practice Address - Phone:859-322-2954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula