Provider Demographics
NPI:1073743290
Name:MUNOZ, AMY K (RD, LMNT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 PRAIRIEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4409
Mailing Address - Country:US
Mailing Address - Phone:308-675-4551
Mailing Address - Fax:308-675-5015
Practice Address - Street 1:3533 PRAIRIEVIEW ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4409
Practice Address - Country:US
Practice Address - Phone:308-675-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE757133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
915456OtherAMERICAN DIETETIC ASSOCIATION
NE757OtherSTATE OF NE