Provider Demographics
NPI:1083384101
Name:RYSKOWSKI, AMANDA LAUREN (NMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LAUREN
Last Name:RYSKOWSKI
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27095 N 69TH LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-5554
Mailing Address - Country:US
Mailing Address - Phone:503-928-9410
Mailing Address - Fax:
Practice Address - Street 1:14991 W BELL RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3874
Practice Address - Country:US
Practice Address - Phone:623-977-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath