Provider Demographics
NPI:1649281775
Name:HAGER, AMY (RDN, CDE)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:HAGER
Suffix:
Gender:F
Credentials:RDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 LUMP GULCH RD
Mailing Address - Street 2:
Mailing Address - City:BLACK HAWK
Mailing Address - State:CO
Mailing Address - Zip Code:80422-4314
Mailing Address - Country:US
Mailing Address - Phone:919-272-7350
Mailing Address - Fax:720-770-5459
Practice Address - Street 1:2841 LUMP GULCH RD
Practice Address - Street 2:
Practice Address - City:BLACK HAWK
Practice Address - State:CO
Practice Address - Zip Code:80422-4314
Practice Address - Country:US
Practice Address - Phone:919-272-7350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002567133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered