Provider Demographics
NPI:1740644624
Name:YERIKE, DEBRA (RDN)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:YERIKE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:YERIKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DIETETICS
Mailing Address - Street 1:213 F ST
Mailing Address - Street 2:#73
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4514
Mailing Address - Country:US
Mailing Address - Phone:530-264-5577
Mailing Address - Fax:
Practice Address - Street 1:213 F ST
Practice Address - Street 2:#73
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4514
Practice Address - Country:US
Practice Address - Phone:530-264-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
WV899133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA800644OtherCDR NUMBER