Provider Demographics
NPI:1619370111
Name:ATKINSON, AMANDA (MA, RD, CD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:MA, RD, CD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:DREGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, RD, CD
Mailing Address - Street 1:10001 S COUNTY ROAD 200 E
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47302-8617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8483 FISHERS CENTER DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2318
Practice Address - Country:US
Practice Address - Phone:317-598-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002141A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered