Active NPI
Amy S Peterson, IBCLC
- Lactation Consultant (Non-RN)
- Jerome, ID
National Provider Identifier
1699017764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Lactation Consultant (Non-RN)
- License
- 101-17560
- Practice address
- 805 4TH Ave Dr
Jerome, ID 83338-2104 - Phone
- (208) 308-1350
- Fax
- (208) 324-9628
- NPI assigned
- Mar 26, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Lactation Consultant (Non-RN) | 174N00000X | 101-17560 | VA | Primary |
Addresses
Primary practice location
805 4TH Ave Dr
Jerome, ID 83338-2104
Mailing address
805 4TH Ave Dr
Jerome, ID 83338-2104
Phone (208) 308-1350
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101-17560 | VA | MD | Lactation Consultant (Non-RN) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364256000000",
"number": "1699017764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "805 4TH AVE DR",
"city": "JEROME",
"state": "ID",
"postal_code": "833382104",
"telephone_number": "208-308-1350",
"fax_number": "208-324-9628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "805 4TH AVE DR",
"city": "JEROME",
"state": "ID",
"postal_code": "833382104",
"telephone_number": "208-308-1350",
"fax_number": "208-324-9628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "AMY",
"middle_name": "S",
"credential": "IBCLC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-26",
"last_updated": "2013-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "174N00000X",
"taxonomy_group": "",
"desc": "Lactation Consultant, Non-RN",
"state": "VA",
"license": "101-17560",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jerome, ID
- Jeffrey Ryan Palmer, DDS
- Morgan B Parker, PHARM.D.
- Jennifer Parsons, NP-C
- Pathways Neurofeedback Institute, PLLC (Pathways Functional Medicine)
- Lizeth Moreno Peoble
- Stacey Michele Pound, M.S., CCC-SLP
- Gary Radford, PHARMD
- Jason Reading, PHARM-D
- Readings Community Pharmacy Inc
- Readings Community Pharmacy Inc (R and R Pharmacy)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.