Provider Demographics
NPI:1609434190
Name:MILLER HALVORSON, DEBORAH ANN (RDN, LD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:MILLER HALVORSON
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:HALVORSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:5397 CLOVER LEAF LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-7616
Mailing Address - Country:US
Mailing Address - Phone:513-316-3088
Mailing Address - Fax:
Practice Address - Street 1:5397 CLOVER LEAF LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-7616
Practice Address - Country:US
Practice Address - Phone:513-316-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.7262133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered