Provider Demographics
NPI:1295507986
Name:ALYSSA DEBORD NUTRITION AND WELLNESS
Entity type:Organization
Organization Name:ALYSSA DEBORD NUTRITION AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBORD
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:206-294-2425
Mailing Address - Street 1:169 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9108
Mailing Address - Country:US
Mailing Address - Phone:206-294-2425
Mailing Address - Fax:
Practice Address - Street 1:110 E ELM ST STE B
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1462
Practice Address - Country:US
Practice Address - Phone:740-206-9499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty