MEDICARE: AMANDA M DEVEREUX RN, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	RN118307	LA
2	163WL0100X	Lactation Consultant (Registered Nurse)	RN118307	LA

General Provider Information

NPI Number	:	1184122202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA M DEVEREUX RN, IBCLC

Provider Business Mailing Address
First Line	:	4628 DEMONTLUZIN ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-6104
Country	:	US
Telephone Number	:	504-655-1819
Fax Number	:

Provider Business Practice Location Address
First Line	:	4628 DEMONTLUZIN ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-6104
Country	:	US
Telephone Number	:	504-655-1819
Fax Number	:	504-655-1819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	01/23/2018

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