Healthcare Provider Details

I. General information

NPI: 1770400764
Provider Name (Legal Business Name): AMANDA PHILLIPS LDN/LN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 90TH AVE
GREELEY CO
80634-5778
US

IV. Provider business mailing address

1829 90TH AVE
GREELEY CO
80634-5778
US

V. Phone/Fax

Practice location:
  • Phone: 720-684-7326
  • Fax:
Mailing address:
  • Phone: 720-684-7326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number19209
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: