Provider Demographics
NPI:1992346514
Name:YEOMAN, AMY (RD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:YEOMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 S CONKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-6235
Mailing Address - Country:US
Mailing Address - Phone:303-918-0569
Mailing Address - Fax:
Practice Address - Street 1:711 N HELENA ST STE C
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2826
Practice Address - Country:US
Practice Address - Phone:303-918-0569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86031097133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered