Provider Demographics
NPI:1700631629
Name:GOLDSTEIN, AMANDA (BSN, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CAPITAL HILL CIR
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-2182
Mailing Address - Country:US
Mailing Address - Phone:301-452-7943
Mailing Address - Fax:
Practice Address - Street 1:260 CAPITAL HILL CIR
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-2182
Practice Address - Country:US
Practice Address - Phone:301-452-7943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.380638163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant