Provider Demographics
NPI:1508450479
Name:AMANDA ETTINGER NUTRITION LLC
Entity Type:Organization
Organization Name:AMANDA ETTINGER NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:207-512-0982
Mailing Address - Street 1:137 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6734
Mailing Address - Country:US
Mailing Address - Phone:207-512-0982
Mailing Address - Fax:
Practice Address - Street 1:137 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6734
Practice Address - Country:US
Practice Address - Phone:207-512-0982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty