Provider Demographics
NPI:1083231831
Name:DEMEREST, JAMES DARRELL (RDN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DARRELL
Last Name:DEMEREST
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9194 LAMONT ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-5406
Mailing Address - Country:US
Mailing Address - Phone:734-625-4572
Mailing Address - Fax:
Practice Address - Street 1:9194 LAMONT ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-5406
Practice Address - Country:US
Practice Address - Phone:734-625-4572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86150187133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered