Provider Demographics
NPI:1851421465
Name:HALL HANEY, AMY LOU (RD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOU
Last Name:HALL HANEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LOU
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:303 A AVE SE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1526
Mailing Address - Country:US
Mailing Address - Phone:319-895-6279
Mailing Address - Fax:319-895-6279
Practice Address - Street 1:701 10TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1251
Practice Address - Country:US
Practice Address - Phone:319-398-6711
Practice Address - Fax:319-369-4633
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00891133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI10202Medicare ID - Type UnspecifiedMNT