Provider Demographics
NPI:1659120087
Name:WOODBURY, AMANDA W (CPM)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:W
Last Name:WOODBURY
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03855-2410
Mailing Address - Country:US
Mailing Address - Phone:603-953-3422
Mailing Address - Fax:
Practice Address - Street 1:194 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03855-2410
Practice Address - Country:US
Practice Address - Phone:603-953-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1201176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife