Healthcare Provider Details

I. General information

NPI: 1952968307
Provider Name (Legal Business Name): AMANDA RUBLEY MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S HEALTH PKWY
THREE RIVERS MI
49093-8352
US

IV. Provider business mailing address

23384 RIVER RUN RD
MENDON MI
49072-9400
US

V. Phone/Fax

Practice location:
  • Phone: 269-273-9607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86086245
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: