Provider Demographics
NPI:1821482944
Name:VAIL, DEBBIE (NC)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:VAIL
Suffix:
Gender:F
Credentials:NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13536 COUNTY ROAD 45
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-6117
Mailing Address - Country:US
Mailing Address - Phone:334-750-3276
Mailing Address - Fax:
Practice Address - Street 1:13536 COUNTY ROAD 45
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-6117
Practice Address - Country:US
Practice Address - Phone:334-750-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR008584499133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education