Provider Demographics
NPI:1568877090
Name:MACHUGA, MARCIA LYNN (RD-CDN)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:LYNN
Last Name:MACHUGA
Suffix:
Gender:F
Credentials:RD-CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BUCKS XING
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-2282
Mailing Address - Country:US
Mailing Address - Phone:860-930-6928
Mailing Address - Fax:
Practice Address - Street 1:14 BUCKS XING
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-2282
Practice Address - Country:US
Practice Address - Phone:860-930-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-833854133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered