Provider Demographics
NPI:1992938799
Name:HAWVER, AMANDA MARIE (RD, LDN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:HAWVER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9732 SELFRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3783
Mailing Address - Country:US
Mailing Address - Phone:443-730-2410
Mailing Address - Fax:
Practice Address - Street 1:9101 FRANKLIN SQUARE DR
Practice Address - Street 2:SUITE # 205
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3936
Practice Address - Country:US
Practice Address - Phone:443-777-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2731133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered