Provider Demographics
NPI:1831428572
Name:NICHOLS, AMANDA RAE (CD(DONA))
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 SE 41ST AVE
Mailing Address - Street 2:APT 46
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3267
Mailing Address - Country:US
Mailing Address - Phone:310-773-6368
Mailing Address - Fax:
Practice Address - Street 1:635 SE 41ST AVE
Practice Address - Street 2:APT 46
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3267
Practice Address - Country:US
Practice Address - Phone:310-773-6368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula