Provider Demographics
NPI:1497536627
Name:AZNAVOUR, MAGGIE (MS, RDN, RD)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:AZNAVOUR
Suffix:
Gender:F
Credentials:MS, RDN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 NORWICH DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2633
Mailing Address - Country:US
Mailing Address - Phone:214-517-2164
Mailing Address - Fax:
Practice Address - Street 1:130 S PRESTON RD STE 30
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-3068
Practice Address - Country:US
Practice Address - Phone:940-222-2399
Practice Address - Fax:940-228-1298
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT89106133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered