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Individual
DEBORAH JANE SMITH
Active
Individual
DEBORAH JANE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LD
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-0803
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
98633708
—
NM
01
—
NMAAA0103
MEDICARE PTAN
—
Enumeration date
12/08/2010
Last updated
09/02/2014
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