Healthcare Provider Details

I. General information

NPI: 1417778564
Provider Name (Legal Business Name): AMANDA LEE HETTEMA CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 MAGNOLIA AVE STE. A
CHICO CA
95926
US

IV. Provider business mailing address

1504 LUPTON AVE
SAN JOSE CA
95125-3848
US

V. Phone/Fax

Practice location:
  • Phone: 530-332-5080
  • Fax:
Mailing address:
  • Phone: 408-218-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: