Provider Demographics
NPI:1780731935
Name:WARD, AMY SARVER (RD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SARVER
Last Name:WARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E SIMMONS ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-1979
Mailing Address - Country:US
Mailing Address - Phone:360-452-5370
Mailing Address - Fax:
Practice Address - Street 1:3080 LOWER ELWHA RD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-8411
Practice Address - Country:US
Practice Address - Phone:360-452-8471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000139133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7084973Medicaid