Individual
MACY REALL
Active
Individual
MACY REALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
DN003393
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN003393
MEDICAL LICENSE
PA
Enumeration date
08/13/2009
Last updated
08/13/2009
Update your record
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