Provider Demographics
NPI:1811233992
Name:TESTA, MARISSA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:TESTA
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1842 MERGANSER RUN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7017
Mailing Address - Country:US
Mailing Address - Phone:614-946-8709
Mailing Address - Fax:
Practice Address - Street 1:1842 MERGANSER RUN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7017
Practice Address - Country:US
Practice Address - Phone:614-946-8709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
OHLD 7102133V00000X
OH7102133VN1004X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic