Provider Demographics
NPI:1831708536
Name:FERRE, AMANDA LAURIE (LM, CPM)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LAURIE
Last Name:FERRE
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 102ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2846
Mailing Address - Country:US
Mailing Address - Phone:425-599-3207
Mailing Address - Fax:
Practice Address - Street 1:12625 102ND AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2846
Practice Address - Country:US
Practice Address - Phone:425-599-3207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW61060777176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA176B00000XMedicaid