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General NPI Number Information
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NPI Number | 1952968307
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Entity Type | Individual
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Provider Name | AMANDA RUBLEY MS, RDN
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Gender | Female
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 701 S HEALTH PKWY
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City | THREE RIVERS
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State | MI
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Zip | 49093-8352
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Country | US
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Telephone | 269-273-9607
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Fax |
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Provider Business Mailing Address
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Address Line | 23384 RIVER RUN RD
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City | MENDON
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State | MI
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Zip | 49072-9400
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Country | US
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Telephone |
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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 | 86086245
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License Number State | MI
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