Provider Demographics
NPI:1295319432
Name:MACE, ERIN A (RDN)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:A
Last Name:MACE
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 1:38 MICHAEL CIR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9493
Mailing Address - Country:US
Mailing Address - Phone:304-634-9045
Mailing Address - Fax:
Practice Address - Street 1:38 MICHAEL CIR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9493
Practice Address - Country:US
Practice Address - Phone:304-634-9045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV690133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered