Provider Demographics
NPI:1518918028
Name:PETERSON, AMY SUZANNE (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUZANNE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6773 ABBEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-5452
Mailing Address - Country:US
Mailing Address - Phone:719-282-3825
Mailing Address - Fax:
Practice Address - Street 1:2350 FAIRCHILD DR
Practice Address - Street 2:
Practice Address - City:U S A F ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-6297
Practice Address - Country:US
Practice Address - Phone:719-333-0258
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered