Provider Demographics
NPI:1376788893
Name:MISENER, DEBRA K (RD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:MISENER
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 1:115 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3618
Mailing Address - Country:US
Mailing Address - Phone:406-454-6950
Mailing Address - Fax:406-453-3357
Practice Address - Street 1:115 4TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3618
Practice Address - Country:US
Practice Address - Phone:406-454-6950
Practice Address - Fax:406-453-3357
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT486133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered