Individual
AMY DAWN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, LDN
Contact information
Practice address
HIGHWAY 169 MILE MARKER 29, ALAMO, NM 87825-5907
(575) 854-2642
(575) 854-2606
Mailing address
PO BOX 5907, HIGHWAY 169 MILE MARKER 29, ALAMO, NM 87825-5907
(575) 854-2642
(575) 854-2606
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-0750
NM
Other
Enumeration date
08/31/2012
Last updated
08/31/2012
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