Provider Demographics
NPI:1114392016
Name:ROSE, AMANDA (CD,PCD( DONA))
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:CD,PCD( DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 VILLARD ST APT 203
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1440
Mailing Address - Country:US
Mailing Address - Phone:541-816-0866
Mailing Address - Fax:
Practice Address - Street 1:2233 VILLARD ST APT 203
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520
Practice Address - Country:US
Practice Address - Phone:541-816-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11349374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula