Individual
AMANDA MICHELLE BOLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
11141 PARKVIEW PLAZA DR, SUITE 210, FORT WAYNE, IN 46845-1713
(260) 347-8187
(260) 347-8023
Mailing address
1234 E. DUPONT RD., SUITE 1, FORT WAYNE, IN 46825-1545
(260) 373-9728
(260) 458-5664
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37002215A
IN
Other
Enumeration date
08/28/2012
Last updated
11/05/2012
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