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General NPI Number Information
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NPI Number | 1033638952
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Entity Type | Individual
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Provider Name | AMY HANNEKE RDN, LD
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Gender | Female
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 320 ASHLAND ST. APT. 1
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City | SODA SPRINGS
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State | ID
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Zip | 83276-8327
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Country | US
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Telephone | 314-591-6429
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Fax |
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Provider Business Mailing Address
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Address Line | 164 S. 5TH ST.
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City | MONTPELIER
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State | ID
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Zip | 83254
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Country | US
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Telephone | 208-847-1630
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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