Provider Demographics
NPI:1255531729
Name:SCHMIDT, AMANDA ELLEN (RD, CD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELLEN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2060
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54702-2060
Mailing Address - Country:US
Mailing Address - Phone:715-831-0100
Mailing Address - Fax:715-831-0108
Practice Address - Street 1:2620 STEIN BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6201
Practice Address - Country:US
Practice Address - Phone:715-831-0100
Practice Address - Fax:715-831-0108
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1535-029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered