Provider Demographics
NPI:1093968273
Name:DONOHOO, MICCA LYNN (RD)
Entity Type:Individual
Prefix:
First Name:MICCA
Middle Name:LYNN
Last Name:DONOHOO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MICCA
Other - Middle Name:LYNN
Other - Last Name:LEMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4488
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62708-4488
Mailing Address - Country:US
Mailing Address - Phone:800-577-5368
Mailing Address - Fax:217-757-2021
Practice Address - Street 1:701 N 1ST ST
Practice Address - Street 2:FOOD AND NUTRITION OFFICE
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62781-0001
Practice Address - Country:US
Practice Address - Phone:217-788-3477
Practice Address - Fax:217-788-5569
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164003788133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered