Provider Demographics
NPI:1861661811
Name:CORBIN, AMANDA NICOLE (RD)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:NICOLE
Last Name:CORBIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:ONE KINGS DAUGHTERS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-3300
Mailing Address - Country:US
Mailing Address - Phone:812-265-0562
Mailing Address - Fax:812-265-0561
Practice Address - Street 1:ONE KINGS DAUGHTERS DRIVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-3300
Practice Address - Country:US
Practice Address - Phone:812-265-0562
Practice Address - Fax:812-265-0561
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1003079133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered