Basic Information
| Provider Information | |||||||||
| NPI: | 1740558030 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STINSON | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | KATHRYN | ||||||||
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| Credential: | MS, RDN, CD, CDCES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | GRAFTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530241700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623753700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 215 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | GRAFTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530241700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623753700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2011 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 01060961 | WI | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 2397 | WI | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.