Provider Demographics
NPI:1376883009
Name:MIQUEL, MARILYN ELIZABETH (RD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:ELIZABETH
Last Name:MIQUEL
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 1:2531 TRENTON AVE
Mailing Address - Street 2:UNIT 103
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1730
Mailing Address - Country:US
Mailing Address - Phone:908-268-2087
Mailing Address - Fax:
Practice Address - Street 1:2531 TRENTON AVE
Practice Address - Street 2:UNIT 103
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1730
Practice Address - Country:US
Practice Address - Phone:908-268-2087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-16
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86007534133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered