Provider Demographics
NPI:1063484111
Name:JOYCE, AMY BAKER (MS, RD, LD, CNSC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BAKER
Last Name:JOYCE
Suffix:
Gender:F
Credentials:MS, RD, LD, CNSC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD, CNSD
Mailing Address - Street 1:135 LESTER DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1613
Mailing Address - Country:US
Mailing Address - Phone:240-381-6716
Mailing Address - Fax:
Practice Address - Street 1:135 LESTER DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1613
Practice Address - Country:US
Practice Address - Phone:240-381-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1083133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered