Provider Demographics
NPI:1790052561
Name:DEMARCO, DANIELLE ALENA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ALENA
Last Name:DEMARCO
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 1:401 N EWING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3372
Mailing Address - Country:US
Mailing Address - Phone:740-687-8468
Mailing Address - Fax:740-687-8365
Practice Address - Street 1:401 N EWING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3372
Practice Address - Country:US
Practice Address - Phone:740-687-8468
Practice Address - Fax:740-687-8365
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6880133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6880OtherDIETETIC LICENSE
OH1013327OtherDIETETIC REGISTRATION