Provider Demographics
NPI:1770049678
Name:MARMILLION, DENISE (RD, LDN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MARMILLION
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 CENTRE ST STE 210B
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1553
Mailing Address - Country:US
Mailing Address - Phone:617-431-6605
Mailing Address - Fax:617-483-6204
Practice Address - Street 1:1280 CENTRE ST STE 210B
Practice Address - Street 2:
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-1553
Practice Address - Country:US
Practice Address - Phone:617-431-6605
Practice Address - Fax:617-483-6204
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4417133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered