Provider Demographics
NPI:1518360882
Name:PROUT, AMY (RD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PROUT
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 1:9252 N GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53209-1104
Mailing Address - Country:US
Mailing Address - Phone:414-527-5261
Mailing Address - Fax:414-365-6356
Practice Address - Street 1:9252 N GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53209-1104
Practice Address - Country:US
Practice Address - Phone:414-527-5261
Practice Address - Fax:414-365-6356
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2269133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered