Provider Demographics
NPI:1386955920
Name:MOLTER, AMANDA HELENE (CNM)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:HELENE
Last Name:MOLTER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5507
Mailing Address - Country:US
Mailing Address - Phone:978-534-8701
Mailing Address - Fax:978-534-8705
Practice Address - Street 1:87 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5507
Practice Address - Country:US
Practice Address - Phone:978-534-8701
Practice Address - Fax:978-534-8705
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN268083367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN268083OtherNURSE MIDWIFE LICENSE NUMBER