Provider Demographics
NPI:1871908699
Name:CORDINGLEY, AMY (RD, LD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CORDINGLEY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S LOCUST ST
Mailing Address - Street 2:STORE #1162
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7419
Mailing Address - Country:US
Mailing Address - Phone:563-583-6148
Mailing Address - Fax:
Practice Address - Street 1:400 S LOCUST ST
Practice Address - Street 2:STORE #1162
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7419
Practice Address - Country:US
Practice Address - Phone:563-583-6148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002139133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered