Provider Demographics
NPI:1992010029
Name:DONALDSON KAISER, DENISE LYNNE (MBA, MS,RD, CDN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNNE
Last Name:DONALDSON KAISER
Suffix:
Gender:F
Credentials:MBA, MS,RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3708
Mailing Address - Country:US
Mailing Address - Phone:631-828-1158
Mailing Address - Fax:
Practice Address - Street 1:8 ROSS ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3708
Practice Address - Country:US
Practice Address - Phone:631-828-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004998-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered