Provider Demographics
NPI:1104647908
Name:DUGGAN, AMANDA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DUGGAN
Suffix:
Gender:
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 NW GILMAN BLVD STE 44
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2485
Mailing Address - Country:US
Mailing Address - Phone:425-523-1212
Mailing Address - Fax:
Practice Address - Street 1:317 NW GILMAN BLVD STE 44
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2485
Practice Address - Country:US
Practice Address - Phone:425-523-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL-315576163WL0100X
WARN60255219163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant