Provider Demographics
NPI:1134319494
Name:SMOLIK, DEBBIE B (LD, RD, CDE)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:B
Last Name:SMOLIK
Suffix:
Gender:F
Credentials:LD, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-1208
Mailing Address - Country:US
Mailing Address - Phone:512-352-7611
Mailing Address - Fax:512-352-4734
Practice Address - Street 1:305 MALLARD LN
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-1208
Practice Address - Country:US
Practice Address - Phone:512-352-7611
Practice Address - Fax:512-352-4734
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX442042133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87N463Medicare PIN
TXP56724Medicare UPIN