Provider Demographics
NPI:1255943908
Name:VARHOL, ALISON MARION (MS, RD, LD/N)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:MARION
Last Name:VARHOL
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:MS
Other - First Name:ALISON
Other - Middle Name:MARION
Other - Last Name:KUCHARSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD/N
Mailing Address - Street 1:95072 WINDFLOWER TRL
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3798
Mailing Address - Country:US
Mailing Address - Phone:908-892-1747
Mailing Address - Fax:
Practice Address - Street 1:95072 WINDFLOWER TRL
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3798
Practice Address - Country:US
Practice Address - Phone:908-892-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006008133V00000X
FL9820133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered