Provider Demographics
NPI:1376668905
Name:STIFTER, AMBER (RD, CD, CDE)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:STIFTER
Suffix:
Gender:F
Credentials:RD, CD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7707 SAVARY DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-7946
Mailing Address - Country:US
Mailing Address - Phone:509-544-0382
Mailing Address - Fax:
Practice Address - Street 1:900 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5621
Practice Address - Country:US
Practice Address - Phone:509-585-5968
Practice Address - Fax:509-586-5140
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001344133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered