Provider Demographics
NPI:1396133617
Name:BJORN, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BJORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:JAKSHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CMR 415 BOX 3231
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09114-0033
Mailing Address - Country:US
Mailing Address - Phone:00491514-047-6256
Mailing Address - Fax:
Practice Address - Street 1:BMEDDAC
Practice Address - Street 2:GEBAUDE 700 ROSE BARRACKS SUED LAGER
Practice Address - City:VILSECK
Practice Address - State:BAYERN
Practice Address - Zip Code:92249
Practice Address - Country:DE
Practice Address - Phone:0049966-283-3216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60165277133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered