Provider Demographics
NPI:1912747155
Name:AMBERRDRX
Entity type:Organization
Organization Name:AMBERRDRX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:317-561-0183
Mailing Address - Street 1:6319 E US HIGHWAY 36 STE 105
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6209
Mailing Address - Country:US
Mailing Address - Phone:317-561-0183
Mailing Address - Fax:
Practice Address - Street 1:6319 E US HIGHWAY 36 STE 105
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6209
Practice Address - Country:US
Practice Address - Phone:317-561-0183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-27
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty