Provider Demographics
NPI:1568081917
Name:SLATER, MARILYN (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:SLATER
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 SE DARLING ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6449
Mailing Address - Country:US
Mailing Address - Phone:561-216-9063
Mailing Address - Fax:
Practice Address - Street 1:1525 SE DARLING ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6449
Practice Address - Country:US
Practice Address - Phone:561-216-9063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7541133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86042511OtherRD LICENSE