Provider Demographics
NPI:1821083247
Name:SMITH, DONNA C (RD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:C
Other - Last Name:SCHUNCKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:435 MDG
Mailing Address - Street 2:UNIT 3215
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09094
Mailing Address - Country:DE
Mailing Address - Phone:0114-963-7147
Mailing Address - Fax:
Practice Address - Street 1:435 MDG
Practice Address - Street 2:UNIT 3215
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09094
Practice Address - Country:DE
Practice Address - Phone:0114-963-7146
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06907133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered