Provider Demographics
NPI:1386138907
Name:ELLIS, AMANDA FRANCES (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:FRANCES
Last Name:ELLIS
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
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Mailing Address - Street 1:915 118TH AVE SE, ATTENTION ALECIA JOHNSON, RET PHYSICA
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:425-243-6922
Mailing Address - Fax:425-452-0704
Practice Address - Street 1:915 118TH AVE SE, ATTENTION ALECIA JOHNSON, RET PHYSICA
Practice Address - Street 2:SUITE 110
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-243-6922
Practice Address - Fax:425-452-0704
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered