Provider Demographics
NPI:1154990737
Name:CARR, AMANDA FAYE DRAGOS (IBCLC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:FAYE DRAGOS
Last Name:CARR
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 PINEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-4346
Mailing Address - Country:US
Mailing Address - Phone:170-779-9817
Mailing Address - Fax:
Practice Address - Street 1:842 PINEWOOD CT
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-4346
Practice Address - Country:US
Practice Address - Phone:707-799-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-165231174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN