Healthcare Provider Details

I. General information

NPI: 1861174849
Provider Name (Legal Business Name): AMY LYNN OSTROSKI RD, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY LYNN VETTER-OSTROSKI RD, CLC

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 LIVERPOOL ST
FORT COLLINS CO
80526-2378
US

IV. Provider business mailing address

3361 LIVERPOOL ST
FORT COLLINS CO
80526-2378
US

V. Phone/Fax

Practice location:
  • Phone: 201-705-6587
  • Fax:
Mailing address:
  • Phone: 201-705-6587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: