Provider Demographics
NPI:1659709483
Name:HOOVER, AMY MARIE (MA, RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:HOOVER
Suffix:
Gender:F
Credentials:MA, RD, CDN
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:AUCIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, RD, CDN
Mailing Address - Street 1:100 PARK ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-1000
Mailing Address - Fax:518-926-2091
Practice Address - Street 1:100 PARK ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4413
Practice Address - Country:US
Practice Address - Phone:518-926-1000
Practice Address - Fax:518-926-2091
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1090428133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered