Healthcare Provider Details

I. General information

NPI: 1740195650
Provider Name (Legal Business Name): AMANDA JEAN MARQUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 GREENWOOD AVE
SWAMPSCOTT MA
01907-2125
US

IV. Provider business mailing address

64 GREENWOOD AVE
SWAMPSCOTT MA
01907-2125
US

V. Phone/Fax

Practice location:
  • Phone: 339-500-0110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: