Individual
MADISON MILLER EBERSOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LDN
Contact information
Practice address
617 CLEVELAND ST, LAKE CHARLES, LA 70601-5364
(337) 309-3588
Mailing address
617 CLEVELAND ST, LAKE CHARLES, LA 70601-5364
(337) 309-3588
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86288708
LA
Other
Enumeration date
05/14/2024
Last updated
05/14/2024
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