Provider Demographics
NPI:1811108772
Name:PATTI, MARIE ANTOINETTE (RD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ANTOINETTE
Last Name:PATTI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 COMMERCE ST
Mailing Address - Street 2:APT 701
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-4302
Mailing Address - Country:US
Mailing Address - Phone:860-884-5184
Mailing Address - Fax:214-767-5522
Practice Address - Street 1:1100 COMMERCE STREET
Practice Address - Street 2:USDA, SOUTHWEST REGIONAL OFFICE
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75242-0000
Practice Address - Country:US
Practice Address - Phone:214-290-9889
Practice Address - Fax:214-767-5522
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000556133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000556OtherSTATE NUTRITIONIST LICENS