Provider Demographics
NPI:1336582295
Name:LODES, AMY MARIE (RD, LD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:LODES
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 SW GOODWIN ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-8224
Mailing Address - Country:US
Mailing Address - Phone:641-494-8979
Mailing Address - Fax:800-541-4369
Practice Address - Street 1:4208 SW GOODWIN ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8224
Practice Address - Country:US
Practice Address - Phone:641-494-8979
Practice Address - Fax:800-541-4369
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002003133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered