Provider Demographics
NPI:1023780319
Name:MICHAUD, AMANDA (LPN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 BLACKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:CATAWBA
Mailing Address - State:VA
Mailing Address - Zip Code:24070-2306
Mailing Address - Country:US
Mailing Address - Phone:508-446-6570
Mailing Address - Fax:
Practice Address - Street 1:5360 BLACKSBURG RD
Practice Address - Street 2:
Practice Address - City:CATAWBA
Practice Address - State:VA
Practice Address - Zip Code:24070-2306
Practice Address - Country:US
Practice Address - Phone:508-446-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0002099904164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse