Provider Demographics
NPI:1679043715
Name:DECKER, AMANDA M (RDN,LDN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:M
Last Name:DECKER
Suffix:
Gender:F
Credentials:RDN,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9709 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-3717
Mailing Address - Country:US
Mailing Address - Phone:814-652-3220
Mailing Address - Fax:814-652-3230
Practice Address - Street 1:9709 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-3717
Practice Address - Country:US
Practice Address - Phone:814-652-3220
Practice Address - Fax:814-652-3230
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-02
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000327133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered