Provider Demographics
NPI:1144393976
Name:VERSAGLI, RAE JEAN (REGISTERED DIETICIAN)
Entity Type:Individual
Prefix:MRS
First Name:RAE JEAN
Middle Name:
Last Name:VERSAGLI
Suffix:
Gender:F
Credentials:REGISTERED DIETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 LOVEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-1515
Mailing Address - Country:US
Mailing Address - Phone:302-235-6074
Mailing Address - Fax:302-235-6001
Practice Address - Street 1:726 LOVEVILLE RD
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-1515
Practice Address - Country:US
Practice Address - Phone:302-235-6074
Practice Address - Fax:302-235-6001
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE504065133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered