Amanda Moon Poulin, RD,LD,CDE

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

D1736 Issued in ME

Practice address

905 Union St
Suite 11
Bangor, ME 04401-3050

Phone

(207) 097-3733

Fax

(207) 973-7424

NPI assigned

Jul 21, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eastern Maine Medical Center

  • Rehabilitation Hospital Unit
  • Bangor, ME
  • NPI 1780674689
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649291006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 UNION ST",
            "address_2": "SUITE 11",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013050",
            "telephone_number": "207-097-3733",
            "fax_number": "207-973-7424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 UNION ST",
            "address_2": "SUITE 11",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013050",
            "telephone_number": "207-097-3733",
            "fax_number": "207-973-7424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULIN",
        "first_name": "AMANDA",
        "middle_name": "MOON",
        "credential": "RD,LD,CDE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ME",
            "license": "D1736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patti Ann Porter, RNC
• Sara Porter, LCSW
• Tabitha Portera, LCPC
• Anthony W Posuniak, FNP-BC
• Erik Ross Potter, LMSW-CC
• Autumn Lynn Poulin
• Thomas G Poulin
• Markos Poulopoulos, M.D.
• Pouzol Physical Therapy, PA
• Philip R Pouzol, PT

• Registered Dietitian in Bangor, ME
• Providers in Bangor, ME by specialty
• Registered Dietitian in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.