Basic Information
| Provider Information | |||||||||
| NPI: | 1598914202 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAERTSON | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | R.D | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | INGOLS | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | JEAN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2100 WEBSTER ST | ||||||||
| Address2: | STE 110 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941152373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153318390 | ||||||||
| FaxNumber: | 4153318380 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 WEBSTER ST | ||||||||
| Address2: | STE 110 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941152373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153318390 | ||||||||
| FaxNumber: | 4153318380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2008 | ||||||||
| LastUpdateDate: | 09/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 964884 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.