Individual
NIA GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSCS, CPT, CES, RD
Contact information
Practice address
4472 DEVONSHIRE DR, YOUNGSTOWN, OH 44512-1035
(201) 245-4902
Mailing address
4472 DEVONSHIRE DR, YOUNGSTOWN, OH 44512-1035
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
171W00000X
Contractor
Primary
—
—
374J00000X
Doula
—
—
Other
Enumeration date
04/24/2023
Last updated
04/24/2023
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