Provider Demographics
NPI:1477941144
Name:AMSTELVEEN, JOANNA (RD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:AMSTELVEEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 SUNNYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-5567
Mailing Address - Country:US
Mailing Address - Phone:904-472-4279
Mailing Address - Fax:
Practice Address - Street 1:3401 UNIVERSITY DR STE 9
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2656
Practice Address - Country:US
Practice Address - Phone:919-730-4542
Practice Address - Fax:910-967-6104
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005913133V00000X
FLND 7150133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered