Provider Demographics
NPI:1164208849
Name:DEANNA FORD NUTRITION & WELLNESS, LLC
Entity Type:Organization
Organization Name:DEANNA FORD NUTRITION & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:512-850-4807
Mailing Address - Street 1:1112 RED BIRD DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-5464
Mailing Address - Country:US
Mailing Address - Phone:512-507-9029
Mailing Address - Fax:512-503-3046
Practice Address - Street 1:1112 RED BIRD DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5464
Practice Address - Country:US
Practice Address - Phone:512-850-4807
Practice Address - Fax:512-503-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty