Provider Demographics
NPI:1659023208
Name:PINKHAM, AMY MARIE (MS RDN LDN CDN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:PINKHAM
Suffix:
Gender:F
Credentials:MS RDN LDN CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:157 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-7961
Practice Address - Country:US
Practice Address - Phone:570-884-3726
Practice Address - Fax:570-884-3728
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN0007288133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered