Individual
MS. MARY ELLEN VIVRETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D., L.D.
Contact information
Practice address
3725 LONG AVE, BEAUMONT, TX 77706-4728
(409) 651-3489
(409) 898-0448
Mailing address
3725 LONG AVE, BEAUMONT, TX 77706-4728
(409) 651-3489
(409) 899-0448
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
16160
TX
133NN1002X
Nutrition Education Nutritionist
DT02946
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16160
REGISTERED DIETITIAN
TX
01
—
DT02946
LICENSED DIETITIAN
TX
Enumeration date
08/09/2013
Last updated
07/01/2015
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