Healthcare Provider Details

I. General information

NPI: 1255574299
Provider Name (Legal Business Name): BETHANY RENEE AMSTUTZ RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS BETHANY RENEE MACKE

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W HIGH ST SUITE 450
LIMA OH
45801-3990
US

IV. Provider business mailing address

750 W HIGH ST STE 250
LIMA OH
45801-3959
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-5069
  • Fax: 419-996-5424
Mailing address:
  • Phone: 419-227-7399
  • Fax: 419-229-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD6291
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: