Basic Information
Provider Information
NPI: 1003005919
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASH
FirstName: AMANDA
MiddleName: E.
NamePrefix: MRS.
NameSuffix:  
Credential: R.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 116 S ENNIS ST
Address2:  
City: PORT ANGELES
State: WA
PostalCode: 983624635
CountryCode: US
TelephoneNumber: 3605041136
FaxNumber:  
Practice Location
Address1: 116 S ENNIS ST
Address2:  
City: PORT ANGELES
State: WA
PostalCode: 983624635
CountryCode: US
TelephoneNumber: 3605041136
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/16/2007
LastUpdateDate: 02/10/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/10/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000XDI00001171WAY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


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