Provider Demographics
NPI:1316189889
Name:KOHL, DEBRA MARY (RD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARY
Last Name:KOHL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4362 W LINDA LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2188
Mailing Address - Country:US
Mailing Address - Phone:602-266-0324
Mailing Address - Fax:602-266-0324
Practice Address - Street 1:4414 E JOAN DE ARC AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-6421
Practice Address - Country:US
Practice Address - Phone:602-266-0324
Practice Address - Fax:602-266-0324
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered