Provider Demographics
NPI:1568797579
Name:DZURKA, MALLORI ANN (RD)
Entity Type:Individual
Prefix:MRS
First Name:MALLORI
Middle Name:ANN
Last Name:DZURKA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:MALLORI
Other - Middle Name:ANN
Other - Last Name:LAHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:805 W. CEDAR
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658
Mailing Address - Country:US
Mailing Address - Phone:989-846-3407
Mailing Address - Fax:989-846-3544
Practice Address - Street 1:805 W. CEDAR
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658
Practice Address - Country:US
Practice Address - Phone:989-846-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered