Provider Demographics
NPI:1841745650
Name:MYRDAL, AMY G (MS, RDN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:G
Last Name:MYRDAL
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 CAMERON RANCH DR
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-8017
Mailing Address - Country:US
Mailing Address - Phone:916-564-8086
Mailing Address - Fax:916-564-8086
Practice Address - Street 1:4925 CAMERON RANCH DR
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-8017
Practice Address - Country:US
Practice Address - Phone:916-564-8086
Practice Address - Fax:916-564-8086
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered