Provider Demographics
NPI:1013736289
Name:BERNHARD, AMY ELIZABETH (MS RD LDN ACSM-CEP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:BERNHARD
Suffix:
Gender:F
Credentials:MS RD LDN ACSM-CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 SEA MIST DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6640
Mailing Address - Country:US
Mailing Address - Phone:248-506-6081
Mailing Address - Fax:
Practice Address - Street 1:1319 SEA MIST DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6640
Practice Address - Country:US
Practice Address - Phone:248-506-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5326133V00000X
IL164.007343133V00000X
NCL007804133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered