Individual
MS. AMY MCCALLISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
18001 N 79TH AVE STE A12, GLENDALE, AZ 85308
(623) 399-6825
(623) 505-3474
Mailing address
18001 N 79TH AVE STE A12, GLENDALE, AZ 85308-8398
(623) 399-6825
(623) 505-3474
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
875272
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
819625
—
AZ
01
—
Z115444
PTAN
—
Enumeration date
01/03/2007
Last updated
03/02/2020
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