Healthcare Provider Details

I. General information

NPI: 1558402255
Provider Name (Legal Business Name): AMANDA SUSAN FELDMANN L.M., C.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 OLYMPIA AVE NE STE 246
RENTON WA
98056-4117
US

IV. Provider business mailing address

401 OLYMPIA AVE NE UNIT 27
RENTON WA
98056-4119
US

V. Phone/Fax

Practice location:
  • Phone: 425-235-4674
  • Fax: 425-235-0125
Mailing address:
  • Phone: 425-235-4674
  • Fax: 425-235-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW00000259
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: