Provider Demographics
NPI:1275632671
Name:MAUPIN, AMY R (RD LD CDE)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:MAUPIN
Suffix:
Gender:F
Credentials:RD LD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 ABALONE LOOP
Mailing Address - Street 2:MESCALERO INDIAN HEALTH SERVICES HOSPITAL
Mailing Address - City:MESCALERO
Mailing Address - State:NM
Mailing Address - Zip Code:88340-0210
Mailing Address - Country:US
Mailing Address - Phone:505-464-3861
Mailing Address - Fax:505-464-4422
Practice Address - Street 1:318 ABALONE LOOP
Practice Address - Street 2:MESCALERO INDIAN HEALTH SERVICES HOSPITAL
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340-0210
Practice Address - Country:US
Practice Address - Phone:505-464-3861
Practice Address - Fax:505-464-4422
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT01613133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01902253Medicaid