Provider Demographics
NPI:1831240803
Name:HERBST, DEBORAH (RD LD CDE)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HERBST
Suffix:
Gender:F
Credentials:RD LD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 W CENTENNIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-2847
Mailing Address - Country:US
Mailing Address - Phone:417-358-8121
Mailing Address - Fax:
Practice Address - Street 1:627 W CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-2847
Practice Address - Country:US
Practice Address - Phone:417-358-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001031329133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered