Provider Demographics
NPI:1437802907
Name:MCDERMOTT, JOANNE ELAINE
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:ELAINE
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:ELAINE
Other - Last Name:MCDERMOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CFNC LSWA
Mailing Address - Street 1:2925 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-2206
Mailing Address - Country:US
Mailing Address - Phone:352-465-3802
Mailing Address - Fax:
Practice Address - Street 1:2925 CYPRESS DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-2206
Practice Address - Country:US
Practice Address - Phone:352-465-3802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist