Provider Demographics
NPI:1194357707
Name:FELDER, MARY FRANCES (MS, RD, LD)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:FRANCES
Last Name:FELDER
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 1:2727 BOULTIER ST APT 315
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2232
Mailing Address - Country:US
Mailing Address - Phone:334-467-6665
Mailing Address - Fax:
Practice Address - Street 1:2900 MCGEHEE RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2151
Practice Address - Country:US
Practice Address - Phone:334-356-1381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2931133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered