Individual
MRS. MARIANTHE DAGAR GORMANOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LDN, RD
Contact information
Practice address
2495 SHREVEPORT HWY # 71, PINEVILLE, LA 71360-4044
(318) 473-0010
Mailing address
2495 SHREVEPORT HWY # 71, PINEVILLE, LA 71360-4044
(318) 473-0010
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
858842
LA
Other
Enumeration date
11/09/2010
Last updated
11/09/2010
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