Provider Demographics
NPI:1013356864
Name:DEANGELIS, AMANDA LYNN (CLD)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:DEANGELIS
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 STONE CUTTER RD
Mailing Address - Street 2:
Mailing Address - City:BELLVUE
Mailing Address - State:CO
Mailing Address - Zip Code:80512-6508
Mailing Address - Country:US
Mailing Address - Phone:970-231-3060
Mailing Address - Fax:
Practice Address - Street 1:179 STONE CUTTER RD
Practice Address - Street 2:
Practice Address - City:BELLVUE
Practice Address - State:CO
Practice Address - Zip Code:80512-6508
Practice Address - Country:US
Practice Address - Phone:970-231-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20131349037374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula