Provider Demographics
NPI:1356542088
Name:SHOEMAKER, DONNA LEE (CN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LEE
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LOCUST AVE
Mailing Address - Street 2:#B
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939
Mailing Address - Country:US
Mailing Address - Phone:415-927-4727
Mailing Address - Fax:415-927-4714
Practice Address - Street 1:27 LOCUST AVE
Practice Address - Street 2:#B
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939
Practice Address - Country:US
Practice Address - Phone:415-927-4727
Practice Address - Fax:415-927-4727
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000391133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist