Healthcare Provider Details

I. General information

NPI: 1356716674
Provider Name (Legal Business Name): AMANDA CRANE RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908-0673
US

IV. Provider business mailing address

PO BOX 800673
CHARLOTTESVILLE VA
22908-0673
US

V. Phone/Fax

Practice location:
  • Phone: 434-465-9366
  • Fax:
Mailing address:
  • Phone: 434-465-9366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: