Provider Demographics
NPI:1669290052
Name:GAYLORD, AMANDA GRACE
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:GRACE
Last Name:GAYLORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3457 ARGONAUT AVE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-5203
Mailing Address - Country:US
Mailing Address - Phone:520-456-7809
Mailing Address - Fax:
Practice Address - Street 1:3457 ARGONAUT AVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5203
Practice Address - Country:US
Practice Address - Phone:520-456-7809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker