Provider Demographics
NPI:1255487401
Name:BEUTLER, AMY MICHELLE (RD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:BEUTLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 SURREY DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-5542
Mailing Address - Country:US
Mailing Address - Phone:785-832-4862
Mailing Address - Fax:
Practice Address - Street 1:2415 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-4827
Practice Address - Country:US
Practice Address - Phone:785-832-4862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P64919Medicare UPIN