Provider Demographics
NPI:1811968928
Name:KRAWCHUK, AMANDA CECILIA (RD, LD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CECILIA
Last Name:KRAWCHUK
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 1:1301 S SCOTT ST
Mailing Address - Street 2:APT 523
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-6205
Mailing Address - Country:US
Mailing Address - Phone:443-857-8221
Mailing Address - Fax:202-269-7434
Practice Address - Street 1:1150 VARNUM ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2180
Practice Address - Country:US
Practice Address - Phone:202-267-7151
Practice Address - Fax:202-269-7434
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered