Provider Demographics
NPI:1093223471
Name:JONES, AMY ERIN (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ERIN
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, RDN, LD
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 82151
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0151
Mailing Address - Country:US
Mailing Address - Phone:503-606-6580
Mailing Address - Fax:
Practice Address - Street 1:3833 SW BOND AVE APT 507
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4741
Practice Address - Country:US
Practice Address - Phone:503-606-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86009133133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered