Provider Demographics
NPI:1629596465
Name:EMCH, AMY MAREE (RD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MAREE
Last Name:EMCH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MAREE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:777 NW 9TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6169
Mailing Address - Country:US
Mailing Address - Phone:541-768-6771
Mailing Address - Fax:541-768-9771
Practice Address - Street 1:3517 NW SAMARITAN DR STE 100
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3768
Practice Address - Country:US
Practice Address - Phone:541-768-4280
Practice Address - Fax:541-768-4931
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPENDINGMedicaid
ORLD-D-10165975OtherSTATE LICENSE