Provider Demographics
NPI:1215604137
Name:LANE, AMANDA RAE (RD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:LANE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RAE
Other - Last Name:OAKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN, CDCES
Mailing Address - Street 1:2900 UNIVERSITY AVE SE APT 305
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3734
Mailing Address - Country:US
Mailing Address - Phone:785-458-2954
Mailing Address - Fax:
Practice Address - Street 1:3901 SW 20TH AVE APT 510
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-4587
Practice Address - Country:US
Practice Address - Phone:785-458-2954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered