MEDICARE: JOANNA AMSTELVEEN 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
1	133V00000X	Registered Dietitian	L005913	NC
2	133V00000X	Registered Dietitian	ND 7150	FL

General Provider Information

NPI Number	:	1477941144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA AMSTELVEEN RD

Provider Business Mailing Address
First Line	:	191 SUNNYBROOK LN
Second Line	:
City	:	LILLINGTON
State	:	NC
Zip	:	27546-5567
Country	:	US
Telephone Number	:	904-472-4279
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 UNIVERSITY DR STE 9
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-2656
Country	:	US
Telephone Number	:	919-730-4542
Fax Number	:	910-967-6104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2015
Last Update Date	:	08/13/2025

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Directions to “ JOANNA AMSTELVEEN RD” Practice Location

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