Healthcare Provider Details

I. General information

NPI: 1811968928
Provider Name (Legal Business Name): AMANDA CECILIA KRAWCHUK RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 VARNUM ST NE
WASHINGTON DC
20017-2180
US

IV. Provider business mailing address

1301 S SCOTT ST APT 523
ARLINGTON VA
22204-6205
US

V. Phone/Fax

Practice location:
  • Phone: 202-267-7151
  • Fax: 202-269-7434
Mailing address:
  • Phone: 443-857-8221
  • Fax: 202-269-7434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: