Provider Demographics
NPI:1407046634
Name:DEMURO, GINA DENISE (MS RD LD CDE)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:DENISE
Last Name:DEMURO
Suffix:
Gender:F
Credentials:MS RD LD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 WHITESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-9110
Mailing Address - Country:US
Mailing Address - Phone:256-878-2382
Mailing Address - Fax:
Practice Address - Street 1:3330 WHITESVILLE RD
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-9110
Practice Address - Country:US
Practice Address - Phone:256-878-2382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1607133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered