Provider Demographics
NPI:1710737721
Name:LEVASSEUR, NINA JOYCE (RDN)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:JOYCE
Last Name:LEVASSEUR
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 CINDY LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1227
Mailing Address - Country:US
Mailing Address - Phone:770-624-7277
Mailing Address - Fax:
Practice Address - Street 1:4531 CINDY LN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1227
Practice Address - Country:US
Practice Address - Phone:770-624-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006892133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered