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1629868104 NPI number — AMY LYNN BURNHAM RN, LDM, IBCLC

NPI Number: 1629868104
Health Care Provider/Practitioner: AMY LYNN BURNHAM RN, LDM, IBCLC

Information about “1629868104” NPI (AMY LYNN BURNHAM RN, LDM, IBCLC) exists in 1629868104 in HTML format HTML  |  1629868104 in plain Text format TXT  |  1629868104 in PDF (Portable Document Format) PDF  |  1629868104 in an XML format XML  formats.

NPI Number : 1629868104 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629868104",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BURNHAM",
    "FirstName": "AMY",
    "MiddleName": "LYNN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RN, LDM, IBCLC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BURNHAM",
    "OtherFirstName": "AMI",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "3000 ELIOT DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOOD RIVER",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97031-9574",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "415-516-8771",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3000 ELIOT DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOOD RIVER",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97031-9574",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "415-516-8771",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/08/2025",
    "LastUpdateDate": "05/08/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "202010479RN",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "176B00000X",
          "TaxonomyName": "Midwife",
          "LicenseNumber": "DEM-LD-10218610",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WL0100X",
          "TaxonomyName": "Lactation Consultant (Registered Nurse)",
          "LicenseNumber": "L-13622",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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