Provider Demographics
NPI:1770337834
Name:THIERY, DAWN MICHELLE (MPH, RD)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELLE
Last Name:THIERY
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:DIMARE THIERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPH, RD
Mailing Address - Street 1:727 WENDT TER
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2206
Mailing Address - Country:US
Mailing Address - Phone:949-291-7953
Mailing Address - Fax:
Practice Address - Street 1:727 WENDT TER
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2206
Practice Address - Country:US
Practice Address - Phone:949-291-7953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered