Provider Demographics
NPI:1811465891
Name:NELSON, DEBORAH (MS, CDN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4307
Mailing Address - Country:US
Mailing Address - Phone:203-820-4800
Mailing Address - Fax:
Practice Address - Street 1:111 WEST AVE
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4307
Practice Address - Country:US
Practice Address - Phone:203-820-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1708133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty