Provider Demographics
NPI:1952129538
Name:GOLANT, AMANDA (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GOLANT
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16056 NE WOODINVILLE DUVALL RD
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8498
Mailing Address - Country:US
Mailing Address - Phone:253-218-9149
Mailing Address - Fax:
Practice Address - Street 1:16056 NE WOODINVILLE DUVALL RD
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8498
Practice Address - Country:US
Practice Address - Phone:253-218-9149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10236755133V00000X
WA60597919133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered