Provider Demographics
NPI:1043011398
Name:LEWIS, AMANDA JOLENE (RDN, CD)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JOLENE
Last Name:LEWIS
Suffix:
Gender:
Credentials:RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3739 N TUMWATER WEST DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-6167
Mailing Address - Country:US
Mailing Address - Phone:801-473-9402
Mailing Address - Fax:
Practice Address - Street 1:2172 E 7200 S
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-9340
Practice Address - Country:US
Practice Address - Phone:866-805-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT973193133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered