Amy Hanneke, RDN, LD
Individual provider Active NPI Registered Dietitian · Soda Springs, ID
NPI 1033638952 · NPPES record last updated Mar 20, 2018
Key facts
- NPI
- 1033638952
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- Practice address
- 320 Ashland St.
Apt. 1
Soda Springs, ID 83276-8327 - Phone
- (314) 591-6429
- NPI assigned
- Sep 12, 2017
- Reactivated
- Mar 20, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Yes |
Addresses
Primary practice location
320 Ashland St.
Apt. 1
Soda Springs, ID 83276-8327
Mailing address
164 S. 5TH St.
Montpelier, ID 83254
Phone (208) 847-1630
Other names
- Amy Lee
Other providers in Soda Springs, ID
- Sherie Ann Flagg
- John K Franson
- Gerald Lee Young MD PA
- Hunter Anthony Goodenough
- Jeffrey Grundhauser
- Healthbeat Physical Therapy
- Healthworks Family Center, Inc.
- Heritage of Soda Springs LLC
- Highline Anesthesia LLC
- Randy Hil
All providers in Soda Springs, ID · Registered Dietitian in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.