Provider Demographics
NPI:1255574299
Name:AMSTUTZ, BETHANY RENEE (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:RENEE
Last Name:AMSTUTZ
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:BETHANY
Other - Middle Name:RENEE
Other - Last Name:MACKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 W HIGH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3959
Mailing Address - Country:US
Mailing Address - Phone:419-227-7399
Mailing Address - Fax:419-229-0123
Practice Address - Street 1:770 W HIGH ST
Practice Address - Street 2:SUITE 450
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3990
Practice Address - Country:US
Practice Address - Phone:419-996-5069
Practice Address - Fax:419-996-5424
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD6291133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMT70542Medicare PIN