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NPI Code Detail

MEDICARE: AMANDA MARIE MINTON RD

MEDICARE: AMANDA MARIE MINTON RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian890328IN

General Provider Information

NPI Number : 1265747141
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA MARIE MINTON RD
Provider Business Mailing Address
First Line : 8641 FAWN LAKE CIR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-9776
Country : US
Telephone Number : 317-407-2793
Fax Number :
Provider Business Practice Location Address
First Line : 8641 FAWN LAKE CIR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-9776
Country : US
Telephone Number : 317-407-2793
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2010
Last Update Date : 08/16/2010

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