Individual
MIRIAM EACKLOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
5510 ALMA LN STE 300, SPRINGFIELD, VA 22151-4028
(703) 642-5990
Mailing address
13112 MOSS RANCH LN, FAIRFAX, VA 22033-3524
(703) 887-9750
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86101057
VA
Other
Enumeration date
09/15/2019
Last updated
11/07/2022
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