Provider Demographics
NPI:1629309109
Name:ZAMBRANO, MIRIAM E (MS, RDN, LMNT)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:E
Last Name:ZAMBRANO
Suffix:
Gender:F
Credentials:MS, RDN, LMNT
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:E
Other - Last Name:FLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7106 PLANDOME CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-1267
Mailing Address - Country:US
Mailing Address - Phone:402-850-8083
Mailing Address - Fax:
Practice Address - Street 1:7106 PLANDOME CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-1267
Practice Address - Country:US
Practice Address - Phone:402-850-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE941133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered