Provider Demographics
NPI:1578756185
Name:DOYLE, MARY JEANNE (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:MARY JEANNE
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 SOUTHWEST HIGGINS AVENUE
Mailing Address - Street 2:UNIT #3
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:245 SOUTHWEST HIGGINS AVENUE
Practice Address - Street 2:UNIT #3
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1449
Practice Address - Country:US
Practice Address - Phone:406-218-8709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT504133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered