Individual
AMANDA MALENFANT
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
TECHNICIAN
Contact information
Practice address
COMDT (CG-1122) U.S. COAST GUARD, 2100 2NS ST. SW, SUITE 5314, WASHINGTON, DC 20593-0001
(757) 483-8596
(757) 483-8610
Mailing address
COMDT (CG-1122) U.S. COAST GUARD, 2100 2NS ST. SW, SUITE 5314, WASHINGTON, DC 20593-0001
(757) 483-8596
(757) 483-8610
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24720000X
TECHNICIAN
VA
Enumeration date
01/10/2006
Last updated
07/08/2007
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