Provider Demographics
NPI:1780940791
Name:MACHETTE, AMANDA (CNM)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:MACHETTE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 TAMPICO
Mailing Address - Street 2:STE 220
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2962
Mailing Address - Country:US
Mailing Address - Phone:718-616-3256
Mailing Address - Fax:
Practice Address - Street 1:110 TAMPICO
Practice Address - Street 2:STE 220
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2962
Practice Address - Country:US
Practice Address - Phone:925-935-5356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2054367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife