Provider Demographics
NPI:1710361597
Name:MERCER, AMANDA LORRAINE (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LORRAINE
Last Name:MERCER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-2713
Mailing Address - Country:US
Mailing Address - Phone:303-656-9221
Mailing Address - Fax:
Practice Address - Street 1:2970 FAIRFAX ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-2713
Practice Address - Country:US
Practice Address - Phone:303-656-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-12
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1051831133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered