=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346638178
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA MACDONALD LM, CPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/01/2015
-----------------------------------------------------
Last Update Date | 07/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 W TAYLOR ST
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-525-1669
-----------------------------------------------------
Fax | 775-313-9615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 W TAYLOR ST
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89509-1724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-525-1669
-----------------------------------------------------
Fax | 775-313-9615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------