Provider Demographics
NPI:1306522677
Name:MAGEN, AMANDA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MAGEN
Suffix:
Gender:F
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 1:1080 UNION MILL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9564
Mailing Address - Country:US
Mailing Address - Phone:856-816-7026
Mailing Address - Fax:
Practice Address - Street 1:1080 UNION MILL RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9564
Practice Address - Country:US
Practice Address - Phone:856-816-7026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJL-311714163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant