Provider Demographics
NPI:1396816534
Name:TAYLOR, MARISA S (MS, RD, LDN, CNSD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:S
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, RD, LDN, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E OAK HILL AVE
Mailing Address - Street 2:NUTRITIONAL SERVICES DEPARTMENT
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4505
Mailing Address - Country:US
Mailing Address - Phone:865-545-7590
Mailing Address - Fax:865-545-8515
Practice Address - Street 1:900 E OAK HILL AVE
Practice Address - Street 2:NUTRITIONAL SERVICES DEPARTMENT
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4505
Practice Address - Country:US
Practice Address - Phone:865-545-7590
Practice Address - Fax:865-545-8515
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1551133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered