Provider Demographics
NPI:1952787277
Name:SMYERS, AMBER M (DI)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:M
Last Name:SMYERS
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:M
Other - Last Name:CHITWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DI
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:25012 104TH AVE SE
Practice Address - Street 2:STE C
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-2821
Practice Address - Country:US
Practice Address - Phone:253-856-3477
Practice Address - Fax:253-856-3478
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60489181133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered