Provider Demographics
NPI:1417778564
Name:HETTEMA, AMANDA LEE (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:HETTEMA
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 LUPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3848
Mailing Address - Country:US
Mailing Address - Phone:408-218-2311
Mailing Address - Fax:
Practice Address - Street 1:1405 MAGNOLIA AVE
Practice Address - Street 2:STE. A
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-332-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife