Provider Demographics
NPI:1114102472
Name:LETORT, NANCY R (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:R
Last Name:LETORT
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-9631
Mailing Address - Country:US
Mailing Address - Phone:228-383-4824
Mailing Address - Fax:228-392-4824
Practice Address - Street 1:6811 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-9631
Practice Address - Country:US
Practice Address - Phone:228-383-4824
Practice Address - Fax:228-393-4824
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1100133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered