Provider Demographics
NPI:1386160315
Name:OBERHOLTZER, AMANDA JOSEPHINE (RD)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JOSEPHINE
Last Name:OBERHOLTZER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:JOSEPHINE
Other - Last Name:CERMINARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:CMR 405 BOX 1926
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09034-0020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:GEB 3377
Practice Address - Street 2:
Practice Address - City:LANDSTUHL
Practice Address - State:RHINELAND PFALZ
Practice Address - Zip Code:66849
Practice Address - Country:DE
Practice Address - Phone:314-590-6127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006102133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered