Healthcare Provider Details

I. General information

NPI: 1538584933
Provider Name (Legal Business Name): AMY BURNHAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2014
Last Update Date: 02/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 HATTIE ST
SAN FRANCISCO CA
94114-1844
US

IV. Provider business mailing address

281 ANDERSON ST
SAN FRANCISCO CA
94110-5604
US

V. Phone/Fax

Practice location:
  • Phone: 415-516-8771
  • Fax:
Mailing address:
  • Phone: 415-516-8771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number759393
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM 184
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-13622
License Number StateCA

VIII. Authorized Official

Name: AMY LYNN BURNHAM
Title or Position: MIDWIFE, LACTATION CONSULTANT
Credential: LM, RN, IBCLC
Phone: 415-516-8771