Provider Demographics
NPI:1104073360
Name:WOLFF, AMANDA FALCONER (MPH, RD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:FALCONER
Last Name:WOLFF
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JEAN
Other - Last Name:FALCONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED DIETITIAN
Mailing Address - Street 1:2745 E VIA DE PALMAS
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-2071
Mailing Address - Country:US
Mailing Address - Phone:805-252-3979
Mailing Address - Fax:
Practice Address - Street 1:2745 E VIA DE PALMAS
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-2071
Practice Address - Country:US
Practice Address - Phone:805-252-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ954463133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered