Healthcare Provider Details

I. General information

NPI: 1790907053
Provider Name (Legal Business Name): AMANDA S. HINKLE RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9084 TECHNOLOGY DR SUITE 500
FISHERS IN
46038-3080
US

IV. Provider business mailing address

8631 SPRINGVIEW DR
MC CORDSVILLE IN
46055-6157
US

V. Phone/Fax

Practice location:
  • Phone: 317-570-1944
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number919172
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: