Provider Demographics
NPI:1366686560
Name:BOTTENBERG, AMY MARIE (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:BOTTENBERG
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W WASHINGTON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3839
Mailing Address - Country:US
Mailing Address - Phone:775-883-3953
Mailing Address - Fax:775-885-2785
Practice Address - Street 1:550 W WASHINGTON ST STE 1
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3839
Practice Address - Country:US
Practice Address - Phone:775-883-3953
Practice Address - Fax:775-885-2785
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered