Healthcare Provider Details

I. General information

NPI: 1710337092
Provider Name (Legal Business Name): AMANDA MAY KNAIN RD, LRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N 7TH ST
BISMARCK ND
58501-4441
US

IV. Provider business mailing address

209 N 7TH ST
BISMARCK ND
58501-4441
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-2855
  • Fax:
Mailing address:
  • Phone: 701-323-2855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number941
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: