Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 1071 | MN |
N | 176B00000X | Midwife | MW342 | FL |
NPI | 1063964765 |
---|---|
Provider Name | Amanda Victoria Pittman |
First Address | Columbia Heights, MN 55421-3022 |
Second Address | Saint Paul, MN 55105-3014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2016 |
Last Update Date | 09/01/2019 |