Provider Demographics
NPI:1629868104
Name:BURNHAM, AMY LYNN (RN, LDM, IBCLC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:RN, LDM, IBCLC
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:
Other - Last Name:BURNHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3000 ELIOT DR
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-9574
Mailing Address - Country:US
Mailing Address - Phone:415-516-8771
Mailing Address - Fax:
Practice Address - Street 1:3000 ELIOT DR
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-9574
Practice Address - Country:US
Practice Address - Phone:415-516-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202010479RN163W00000X
ORDEM-LD-10218610176B00000X
ORL-13622163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No176B00000XOther Service ProvidersMidwife