Provider Demographics
NPI:1639349160
Name:BERNS, AMY ELIZABETH (RD CDE)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:ELIZABETH
Last Name:BERNS
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:363 FREMONT ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3389
Mailing Address - Country:US
Mailing Address - Phone:269-245-8190
Mailing Address - Fax:269-245-8035
Practice Address - Street 1:363 FREMONT ST
Practice Address - Street 2:SUITE 308
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3389
Practice Address - Country:US
Practice Address - Phone:269-245-8190
Practice Address - Fax:269-245-8035
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI960527133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered