Provider Demographics
NPI:1538584933
Name:AMY BURNHAM
Entity type:Organization
Organization Name:AMY BURNHAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE, LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LM, RN, IBCLC
Authorized Official - Phone:415-516-8771
Mailing Address - Street 1:281 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-5604
Mailing Address - Country:US
Mailing Address - Phone:415-516-8771
Mailing Address - Fax:
Practice Address - Street 1:62 HATTIE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1844
Practice Address - Country:US
Practice Address - Phone:415-516-8771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-22
Last Update Date:2014-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA759393163WM0102X
CALM 184176B00000X
CAL-13622163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty