Provider Demographics
NPI:1073027934
Name:DIEDE, AMANDA (MPH, RDN, CD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DIEDE
Suffix:
Gender:F
Credentials:MPH, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10214A 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-4939
Mailing Address - Country:US
Mailing Address - Phone:703-568-9239
Mailing Address - Fax:
Practice Address - Street 1:1700 WESTLAKE AVE N STE 400
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-6236
Practice Address - Country:US
Practice Address - Phone:206-309-9232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60809210133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered