Provider Demographics
NPI:1407600935
Name:DEGAN, DANA R (RDN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:R
Last Name:DEGAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 BUCKINGHAM PLACE RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-9177
Mailing Address - Country:US
Mailing Address - Phone:704-351-5082
Mailing Address - Fax:
Practice Address - Street 1:143 BUCKINGHAM PLACE RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-9177
Practice Address - Country:US
Practice Address - Phone:704-351-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003462133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic