Provider Demographics
NPI:1184122202
Name:DEVEREUX, AMANDA M (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:DEVEREUX
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 1:4628 DEMONTLUZIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-6104
Mailing Address - Country:US
Mailing Address - Phone:504-655-1819
Mailing Address - Fax:
Practice Address - Street 1:4628 DEMONTLUZIN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-6104
Practice Address - Country:US
Practice Address - Phone:504-655-1819
Practice Address - Fax:504-655-1819
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN118307174400000X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty