Healthcare Provider Details

I. General information

NPI: 1053597195
Provider Name (Legal Business Name): AMANDA MOORE CPM, LDM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2008
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 AHUWALE PL
MAKAWAO HI
96768-8864
US

IV. Provider business mailing address

111 AHUWALE PL
MAKAWAO HI
96768-8864
US

V. Phone/Fax

Practice location:
  • Phone: 541-520-8394
  • Fax:
Mailing address:
  • Phone: 541-520-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: