Individual
DEBRA ANN SUPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 797-8738
Mailing address
6541 FLOYD HWY N., CHECK, VA 24072
(797) 285-8924
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
8606680
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86066280
COMMISSION ON DIETETIC REGISTRATION
VA
Enumeration date
09/14/2021
Last updated
09/14/2021
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