Provider Demographics
NPI:1477162782
Name:AMBACH, JAMIE (RD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:AMBACH
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 1:198 SHERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1540
Mailing Address - Country:US
Mailing Address - Phone:508-942-6620
Mailing Address - Fax:
Practice Address - Street 1:198 SHERWOOD CIR
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1540
Practice Address - Country:US
Practice Address - Phone:508-942-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered