Provider Demographics
NPI:1184879132
Name:COBB, DEANNA H (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:H
Last Name:COBB
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:DEANNA
Other - Middle Name:H
Other - Last Name:TEMPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1000 MCKINLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6399
Mailing Address - Country:US
Mailing Address - Phone:740-383-8458
Mailing Address - Fax:740-375-2015
Practice Address - Street 1:1000 MCKINLEY PARK DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6399
Practice Address - Country:US
Practice Address - Phone:740-383-8458
Practice Address - Fax:740-375-2015
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6080133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1215935366Medicare PIN