Provider Demographics
NPI:1245668011
Name:DAVISSON, RHONDA SUE (RD, LD)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:SUE
Last Name:DAVISSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 COAKLEY DR
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-2304
Mailing Address - Country:US
Mailing Address - Phone:419-236-4298
Mailing Address - Fax:
Practice Address - Street 1:200 E HIGH ST FL 2
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4424
Practice Address - Country:US
Practice Address - Phone:419-879-8539
Practice Address - Fax:419-222-6212
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3519133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered