Provider Demographics
NPI:1154676005
Name:NORRED, MARY VIRGINIA (RD/LDN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:VIRGINIA
Last Name:NORRED
Suffix:
Gender:F
Credentials:RD/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 DESIARD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7722
Mailing Address - Country:US
Mailing Address - Phone:318-428-9361
Mailing Address - Fax:318-428-7200
Practice Address - Street 1:1650 DESIARD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7722
Practice Address - Country:US
Practice Address - Phone:318-428-9361
Practice Address - Fax:318-428-7200
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA709133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered