Healthcare Provider Details

I. General information

NPI: 1063796365
Provider Name (Legal Business Name): ANDREA MARIE MILLER R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA MARIE PIETRYKOWSKI R.D., L.D.

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 WESTFIELD DR STE 1
ARCHBOLD OH
43502-1005
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 419-445-2015
  • Fax: 419-445-8102
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.6803
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: