Healthcare Provider Details

I. General information

NPI: 1629868104
Provider Name (Legal Business Name): AMY LYNN BURNHAM RN, LDM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMI BURNHAM

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ELIOT DR
HOOD RIVER OR
97031-9574
US

IV. Provider business mailing address

3000 ELIOT DR
HOOD RIVER OR
97031-9574
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 Code163W00000X
TaxonomyRegistered Nurse
License Number202010479RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberDEM-LD-10218610
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-13622
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: