Healthcare Provider Details

I. General information

NPI: 1245164326
Provider Name (Legal Business Name): AMANDA ROSE BOSSERT RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 STARTOWN RD APT 207
HICKORY NC
28602-8002
US

IV. Provider business mailing address

2013 STARTOWN RD APT 207
HICKORY NC
28602-8002
US

V. Phone/Fax

Practice location:
  • Phone: 765-490-0536
  • Fax:
Mailing address:
  • Phone: 765-490-0536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL009728
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: