Individual
AMANDA JEANETTE DEVILLIERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNS, LDN
Contact information
Practice address
417 S 51ST ST APT 3, PHILADELPHIA, PA 19143-1607
(570) 575-6353
Mailing address
417 S 51ST ST APT 3, PHILADELPHIA, PA 19143-1607
(570) 575-6353
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
DN006941
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17610
CERTIFIED NUTRITION SPECIALIST (CNS)
—
01
—
DN006941
DIETITIAN-NUTRITIONIST (LDN)
PA
Enumeration date
03/18/2022
Last updated
03/18/2022
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