Healthcare Provider Details

I. General information

NPI: 1154509552
Provider Name (Legal Business Name): AMANDA WILLIAMS ROBERTSON RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 4TH ST NW
HICKORY NC
28601-2446
US

IV. Provider business mailing address

1404 4TH ST NW
HICKORY NC
28601-2446
US

V. Phone/Fax

Practice location:
  • Phone: 828-413-4186
  • Fax:
Mailing address:
  • Phone: 828-413-4186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberL003060
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: