Individual
ANTONIA DRYSDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NUTR.
Contact information
Practice address
302 E 24TH ST, BRYAN, TX 77803-5303
(979) 822-6467
(979) 821-9448
Mailing address
PO BOX 4588, BRYAN, TX 77805-4588
(979) 822-6467
(979) 821-9448
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT00515
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126130708
—
TX
01
—
DT00515
DIETITIANS STATE LINCENSE
TX
Enumeration date
03/26/2007
Last updated
07/09/2007
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