Provider Demographics
NPI:1306556980
Name:BLAKE UNRUH, AMANDA CLAIRE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CLAIRE
Last Name:BLAKE UNRUH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77600 CALIFORNIA DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-8007
Mailing Address - Country:US
Mailing Address - Phone:310-237-3366
Mailing Address - Fax:
Practice Address - Street 1:77600 CALIFORNIA DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-8007
Practice Address - Country:US
Practice Address - Phone:310-237-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula