Healthcare Provider Details

I. General information

NPI: 1508421918
Provider Name (Legal Business Name): NICOLE MICHELLE AMADOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 E MONTEREY WAY
PHOENIX AZ
85012-2616
US

IV. Provider business mailing address

15720 MEADOW RD APT L1
LYNNWOOD WA
98087-6566
US

V. Phone/Fax

Practice location:
  • Phone: 480-565-2165
  • Fax: 602-889-2444
Mailing address:
  • Phone: 206-612-6933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: