Provider Demographics
NPI:1083481204
Name:LINER, ARIANNE MICHELLE (NDTR)
Entity Type:Individual
Prefix:
First Name:ARIANNE
Middle Name:MICHELLE
Last Name:LINER
Suffix:
Gender:F
Credentials:NDTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 SHRIMPERS ROW
Mailing Address - Street 2:
Mailing Address - City:DULAC
Mailing Address - State:LA
Mailing Address - Zip Code:70353-2405
Mailing Address - Country:US
Mailing Address - Phone:504-220-8617
Mailing Address - Fax:
Practice Address - Street 1:6509 SHRIMPERS ROW
Practice Address - Street 2:
Practice Address - City:DULAC
Practice Address - State:LA
Practice Address - Zip Code:70353-2405
Practice Address - Country:US
Practice Address - Phone:504-220-8617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA86075117136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered