Provider Demographics
NPI:1528540614
Name:CUTLER, MARLO JOAN (MS, CNS, LDN)
Entity Type:Individual
Prefix:
First Name:MARLO
Middle Name:JOAN
Last Name:CUTLER
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35972 HUNTINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19967-6834
Mailing Address - Country:US
Mailing Address - Phone:440-666-4723
Mailing Address - Fax:
Practice Address - Street 1:35972 HUNTINGTON ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967-6834
Practice Address - Country:US
Practice Address - Phone:440-666-4723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4179133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist