Individual
MS. MARJORIE DEBRUYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CDE
Contact information
Practice address
300 N SHEFFIELD DR, BLOOMINGTON, IN 47408-3141
(812) 340-4503
Mailing address
300 N SHEFFIELD DR, BLOOMINGTON, IN 47408-3141
(812) 340-4503
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37000857A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37000857A
STATE (LD) LICENSE NUMBER
IN
01
—
696214
ACADEMY OF NUTRITION AND DIETETICS
—
Enumeration date
05/26/2009
Last updated
06/03/2016
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