Provider Demographics
NPI:1316236318
Name:ELDERKIN, AMANDA (CPM, LM)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ELDERKIN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 JEANNETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2471
Mailing Address - Country:US
Mailing Address - Phone:707-827-3085
Mailing Address - Fax:
Practice Address - Street 1:8805 JEANNETTE AVE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-2471
Practice Address - Country:US
Practice Address - Phone:707-827-3085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife