Healthcare Provider Details

I. General information

NPI: 1306382874
Provider Name (Legal Business Name): AMANDA CULLEN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 SALTERE RD
CLAYTON DE
19938-9715
US

IV. Provider business mailing address

884 SALTERE RD
CLAYTON DE
19938-9715
US

V. Phone/Fax

Practice location:
  • Phone: 302-547-8378
  • Fax:
Mailing address:
  • Phone: 302-547-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: