Provider Demographics
NPI:1629867908
Name:PENCE, AMANDA CATHLEEN (FNTP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CATHLEEN
Last Name:PENCE
Suffix:
Gender:X
Credentials:FNTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 N SHOSHONE LOOP
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-9028
Mailing Address - Country:US
Mailing Address - Phone:858-401-3645
Mailing Address - Fax:
Practice Address - Street 1:941 N SHOSHONE LOOP
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-9028
Practice Address - Country:US
Practice Address - Phone:858-401-3645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education