Provider Demographics
NPI:1316087406
Name:MAGNUSON, AMY FOSTER (PHD)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:FOSTER
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 LEARNING WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-4178
Mailing Address - Country:US
Mailing Address - Phone:850-644-6230
Mailing Address - Fax:850-644-4251
Practice Address - Street 1:960 LEARNING WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-4178
Practice Address - Country:US
Practice Address - Phone:850-644-6230
Practice Address - Fax:850-644-4251
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3244133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered