Healthcare Provider Details

I. General information

NPI: 1639933039
Provider Name (Legal Business Name): AMANDA PREVEL-RAMOS RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 RHONE CIR STE 101
ANCHORAGE AK
99508-5054
US

IV. Provider business mailing address

3730 RHONE CIR STE 101
ANCHORAGE AK
99508-5054
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-5152
  • Fax: 907-562-2585
Mailing address:
  • Phone: 907-561-5152
  • Fax: 907-562-2585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number125806
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: