Provider Demographics
NPI:1699584029
Name:DEROSIA-NEAL, AMYAH LYNN (DOULA)
Entity type:Individual
Prefix:
First Name:AMYAH
Middle Name:LYNN
Last Name:DEROSIA-NEAL
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 WILLA LN SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4640
Mailing Address - Country:US
Mailing Address - Phone:971-240-3103
Mailing Address - Fax:
Practice Address - Street 1:3345 WILLA LN SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4640
Practice Address - Country:US
Practice Address - Phone:971-240-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR112970374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula