Individual
AMANDA THURSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, CD, CDE
Contact information
Practice address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 373-4280
Mailing address
708 N TK WAY, YORKTOWN, IN 47396-8019
(540) 998-1129
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1015791
IN
Other
Enumeration date
01/06/2017
Last updated
01/06/2017
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