Provider Demographics
NPI:1477198653
Name:FEDORIS, ALLISON ANN (RDN, MS, LDN)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:ANN
Last Name:FEDORIS
Suffix:
Gender:F
Credentials:RDN, MS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 BEVENDEAN DR UNIT D9
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6691
Mailing Address - Country:US
Mailing Address - Phone:319-572-5262
Mailing Address - Fax:
Practice Address - Street 1:2424 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5315
Practice Address - Country:US
Practice Address - Phone:615-861-9146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3692133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered