Provider Demographics
NPI:1003522947
Name:ANDRUS, AMANDA (MS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ANDRUS
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 MATCHPOINT DR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-4570
Mailing Address - Country:US
Mailing Address - Phone:208-520-0938
Mailing Address - Fax:
Practice Address - Street 1:450 NW GILMAN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2722
Practice Address - Country:US
Practice Address - Phone:425-835-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education