Provider Demographics
NPI:1124480587
Name:DEAHL-GREENLAW, AMY (RDN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DEAHL-GREENLAW
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 WATFORD LN
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1750
Mailing Address - Country:US
Mailing Address - Phone:610-220-6085
Mailing Address - Fax:
Practice Address - Street 1:581 WATFORD LN
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1750
Practice Address - Country:US
Practice Address - Phone:610-220-6085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000633133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist