Provider Demographics
NPI:1003522947
Name:ANDRUS, AMANDA (MS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ANDRUS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 MATCHPOINT DR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-4570
Mailing Address - Country:US
Mailing Address - Phone:208-520-0938
Mailing Address - Fax:
Practice Address - Street 1:285 N EL CAMINO REAL STE 211
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5385
Practice Address - Country:US
Practice Address - Phone:877-381-4115
Practice Address - Fax:858-901-1461
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education