Provider Demographics
NPI:1174633770
Name:MATHERNE, DONNA COX (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:COX
Last Name:MATHERNE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAMEDDAC WUERZBURG
Mailing Address - Street 2:ATTN: CREDENTIALS UNIT 26610
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09244
Mailing Address - Country:DE
Mailing Address - Phone:01149931-804-3616
Mailing Address - Fax:01149931-804-3241
Practice Address - Street 1:COMMANDER, USA MEDDAC WUERZBURG, UNIT 26610
Practice Address - Street 2:ATTN: NUTRITION CARE DIVISION/ DONNA MATHERNE
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09244
Practice Address - Country:US
Practice Address - Phone:01149931-804-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1038133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered