Provider Demographics
NPI:1811354996
Name:BOBGAN, AMANDA ANN (CBD)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ANN
Last Name:BOBGAN
Suffix:
Gender:F
Credentials:CBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26154 242ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-7121
Mailing Address - Country:US
Mailing Address - Phone:619-838-3072
Mailing Address - Fax:
Practice Address - Street 1:26154 242ND AVE SE
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-7121
Practice Address - Country:US
Practice Address - Phone:619-838-3072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603462553374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula