Healthcare Provider Details

I. General information

NPI: 1508613621
Provider Name (Legal Business Name): AMANDA NICOLE ESCALERA-TORRES RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 S CENTER RD
BURTON MI
48519
US

IV. Provider business mailing address

2065 S CENTER RD
BURTON MI
48519
US

V. Phone/Fax

Practice location:
  • Phone: 810-262-2301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86391948
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: