Provider Demographics
NPI:1952854101
Name:AHOLA, DEBRA ANN (RDN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:AHOLA
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 1:1913 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-4111
Mailing Address - Country:US
Mailing Address - Phone:518-368-7579
Mailing Address - Fax:
Practice Address - Street 1:1913 DEAN ST
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-4111
Practice Address - Country:US
Practice Address - Phone:518-368-7579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-24
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86050058133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered