Healthcare Provider Details

I. General information

NPI: 1619370111
Provider Name (Legal Business Name): AMANDA ATKINSON M.A., R.D., C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA DREGER M.A., R.D., C.D.

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8483 FISHERS CENTER DR
FISHERS IN
46038-2318
US

IV. Provider business mailing address

10001 S COUNTY ROAD 200 E
MUNCIE IN
47302-8617
US

V. Phone/Fax

Practice location:
  • Phone: 317-598-8887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37002141A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: