Provider Demographics
NPI:1447637889
Name:BOYENS, AMBER (RD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BOYENS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:RAE
Other - Last Name:STANDISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MN
Mailing Address - Zip Code:56256-1620
Mailing Address - Country:US
Mailing Address - Phone:651-336-3481
Mailing Address - Fax:
Practice Address - Street 1:515 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MN
Practice Address - Zip Code:56256-1620
Practice Address - Country:US
Practice Address - Phone:651-336-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1040687133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered