Individual
MRS. DENISE LISE MADORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CSP, CNSC
Contact information
Practice address
2 COLAWICKI DR, NORTH YARMOUTH, ME 04097-6752
(804) 433-5682
Mailing address
2 COLAWICKI DR, NORTH YARMOUTH, ME 04097-6752
(804) 433-5682
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
871573
VA
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004909976
—
VA
Enumeration date
05/23/2007
Last updated
06/17/2011
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